NHS: Workforce Implementation Plan
 - Question

Lord Clark of Windermere: To ask Her Majesty’s Government when they intend to publish the NHS Workforce Implementation Plan which was announced in the NHS Long Term Plan, published on 7 January.

Baroness Manzoor: My Lords, the chair of NHS Improvement and the chair of Health Education England will present initial recommendations to DHSE in spring 2019. A final workforce implementation will follow later in the year, taking into account the outcomes of the spending review. The new national workforce group will consider key areas including the future workforce, making the NHS the best place to work, leadership development and talent management.

Lord Clark of Windermere: My Lords, I thank the Minister for her Answer. Does she accept that there are currently over 110,000 vacancies in the NHS, yet only last week the Government announced that they were to recruit 20,000 pharmacists, physios and paramedics to assist GPs? Where are these people going to come from?

Baroness Manzoor: My Lords, this Government are committed to an NHS and social care that work for everyone. In 2018, we committed to increasing NHS funding by an average of 3.4% year on year, meaning that by 2023-24 the NHS will receive £20.5 billion a year more than it currently does, giving the around 1 million NHS staff a well-deserved pay rise with all staff receiving at least a 3% pay increase by the end of 2018-19. We are increasing the number of training places for doctors, nurses and midwives, with more GPs than ever starting training in the NHS this year. We are delivering an additional 1,500 undergraduate medical places as part of the extension, opening five new medical schools across England.
However, I take on board the point that the noble Lord is making. We also have short-term strategies in place, which means that we are looking at increasing the workforce even further.

Baroness Walmsley: My Lords, is the Minister aware that the planned rollout of the new, more sensitive screening test for bowel cancer has been delayed because of a shortage of appropriate staff to undertake the follow-ups? That is life-saving work. What is the Government’s plan to correct the situation?

Baroness Manzoor: My Lords, as I have said, we have already put in place significant actions to boost the supply of nurses, ranging from training more  nurses to offering new routes into the profession and enhancing reward and pay packages to make nursing more attractive, improve retention and encourage those who have left to return to nursing. There are almost 13,400 more nurses on our wards since 2010. However, we are certainly not complacent.

Baroness Chisholm of Owlpen: My Lords, does my noble friend agree that it is going to be an advantage that all newly qualified nurses and midwives are going to be guaranteed a place in a hospital for the first five years, and are going to be guaranteed a place in the region where they qualified?

Just say yes.

Baroness Manzoor: Yes, my Lords, I agree. Every nurse or midwife graduating will be offered a five-year NHS job guarantee within the region where they qualify. I might also say that an extra 5,000 places will be funded from 2019-20 for clinical placements—a 25% increase. From 2021, we will provide funding for as many places as universities fill—up to a 50% increase—and we are making training much more accessible with a new online nursing degree, costing students a lot less money than currently.

Baroness Thornton: My Lords, could the Minister assure the House that, when the noble Baroness, Lady Harding, conducts her workforce review, she consults not only the BMA and the royal colleges but the trade unions representing the people who clean our hospitals and serve meals, and the porters, ambulance drivers, paramedics, receptionists and auxiliary workers? This includes Unison, Unite, GMB, the Chartered Society of Physiotherapy, the Society of Radiographers and so on.

Baroness Manzoor: My Lords, I cannot see my noble friend Lady Harding in her place, but of course NHS Improvement will consult at the widest level to ensure that views are gathered from all concerned.

Lord Stirrup: My Lords, the Minister refers frequently to recruitment, but the more pressing need is the retention of trained and experienced personnel. The long-term plan has some measures aimed at this, but the need is immediate. What thought has been given to local, flexible and urgent measures to improve the morale and retention of experienced personnel in the NHS?

Baroness Manzoor: The noble and gallant Lord makes an excellent point. We are looking at flexibility for nurses and GPs. Indeed, we are looking at shortened training of up to four years, as well as models of training for doctors, so there is much greater flexibility for the workforce. It is very important to ensure we support our workforce as best we possibly can.

Bishop of St Albans: My Lords, it is encouraging to hear that the long-term plan will include funding for services for those with gambling addictions. With 430,000 gambling addicts in this country, of which 55,000 are teenagers, this is a really urgent matter. Can we press Her Majesty’s Government please  to move on this quickly? There is only one NHS clinic available at the moment. If funding is an issue, will the Government explore the possibility of introducing a mandatory levy on the gambling industry to pay for the cost to the NHS, which Simon Stevens suggests is £1.2 billion?

Baroness Manzoor: My Lords, the right reverend Prelate is right that gambling is an issue. We are doing everything we can to ensure that the industry itself takes this seriously. Equally, in the NHS, we see that some of the issues are health related and we need to do more.

Baroness Tonge: My Lords, when the Healthcare (International Arrangements) Bill that we are discussing this afternoon is eventually passed by the two Houses, will we be able to go to Europe to get our healthcare there from the health professionals who used to be here?

Baroness Manzoor: My Lords, the reciprocal healthcare agreement is extremely important. The Government deeply value the contribution of the 63,000 EU nationals currently working in NHS trusts and CCGs and the 104,000 EU nationals working in social care jobs. We are absolutely clear that we want them to stay and work in the UK after we leave the EU.

Westminster: Security
 - Question

Baroness Rawlings: To ask Her Majesty’s Government what plans they have to review security in the vicinity of the Palace of Westminster.

Baroness Williams of Trafford: My Lords, the Government provide a wide range of advice and guidance to the public about threats and how they can be mitigated. It is a matter for the owners and operators of crowded places to consider this advice and take forward appropriate security measures.

Baroness Rawlings: My Lords, I thank the Minister for her Answer. Security is vitally important not only around Westminster but across the whole country. My concern is about bridges and the plight of pedestrians, as described by Athena in Country Life this week. The solid security barriers along bridges could be potentially dangerous for pedestrians trapped in these pens. Would the Minister agree that it is unacceptable for hundreds of pedestrians to be forced—kettled like demonstrators—along bridges, funnelled through the too narrow spaces created by what was probably meant to be a temporary measure but is now a permanent one?
These barriers present a new crush risk, with huge selfie-taking crowds rambling across the bridges. Should there be any accident, there is no escape. Can the Minister look into suggestions that these security barriers be replaced by security bollards which are far less obtrusive and would avoid many of the security barrier problems?

Baroness Williams of Trafford: My noble friend will appreciate that the physical intervention in a specific place is based on both the threat and protection of the public. The measures—known as hostile vehicle mitigation measures—were put in place after the terrorist attack in London. It cannot be forgotten that the public need to be protected, even if they might undergo some temporary inconvenience. The hostile vehicle mitigation measures are temporary although they will stay until permanent solutions, which are being looked at, are in place.

Lord West of Spithead: My Lords, has there been a security assessment of the full implications of the new Holocaust museum, particularly its learning centre, which will occupy the bulk of the Victoria Tower Gardens site? If there has, what does it mean for additional policing and congestion in the region?

Baroness Williams of Trafford: The noble Lord raises an important point in the light of the various anti-Semitic incidents that have taken place recently. Ministers have agreed to fund security measures on an exceptional basis, as part of the Westminster ceremonial streetscape project. I am not entirely certain whether that project extends down to the Victoria Tower Gardens, but I shall find out for him. However, it is important that such places are fully protected. Assessments of the threat in and around Westminster are of course carried out every day.

Lord Paddick: My Lords, we have all seen the ugly scenes outside Parliament of parliamentarians being subject to abuse. The worrying thing about the enhanced security in the vicinity of Parliament is the number of officers who are being taken away from policing their local communities, or having yet more days off cancelled, to provide the security necessary because of the mishandling of Brexit by this Government. Will the Home Office reimburse the Metropolitan Police for dealing with these problems, which the Government have created?

Baroness Williams of Trafford: My Lords, I think that is a bit of a low blow. It is certainly understood that any protective measures needed will have to be paid for by the authorities which commission them. If the Metropolitan Police is needed, its time and effort will therefore have to be paid for. I have seen many demonstrations outside the Houses of Parliament on a range of issues and I thank the police, who stand ready to protect the public and Members of Parliament from them.

Lord Laming: Will the Minister take this opportunity to thank the staff of both Houses and those in the Metropolitan Police, who work incredibly hard to keep us, our guests and the visitors to this building safe? They deserve full credit.

Baroness Williams of Trafford: The noble Lord is right and I thank them again, because they provide an absolutely fantastic service to us in such a courteous way. I do not know whether the noble Lord was at the excellent security briefing yesterday for Members of your Lordships’ House; it was a very good occasion at which to raise some of our concerns.

Lord Kennedy of Southwark: My Lords, I join the Minister in paying tribute to the police and everybody else who protects us and the staff of the House. I know that she agrees with me that Members of both Houses, their staff, other officials and members of the public have the right to come in and out of Parliament free from abuse, harassment or intimidation—along with the right of people to protest peacefully. Will the Minister agree to keep the situation under urgent review with the relevant authorities and report back to Parliament on any measure deemed necessary to protect these important freedoms?

Baroness Williams of Trafford: The noble Lord raises a really important point about the right to protest. I think I am known by name by some of our friends standing across the road, voicing their support for—or against—Brexit. There are updates every day about the threat to this estate and the vicinity, and I am certainly happy to update noble Lords about any emerging threats.

Lord Dobbs: My Lords, does my noble friend accept that we all have a duty and responsibility to help the security staff as much as we can? One of the first pieces of information we are given on entering the building is that we should make sure we are wearing our ID passes. Looking along the Labour Front Bench, I am not sure I can find many that are actually visible—they may be very well hidden. Do we not all have a duty to help the staff protect us?

Baroness Williams of Trafford: I have got mine too. There should be none of this, “Do you not know who I am?”; I have never heard people say that in this House. The only reason we are ever asked is in order to protect us.

Lord Clark of Windermere: My Lords, it used to be a cardinal democratic principle that elected representatives of our people had the right to attend Parliament and voice opinions on behalf of those constituents. Is that still the case?

Baroness Williams of Trafford: It absolutely is, and it is the central plank of our Parliamentary democracy.

Brexit: Article 50
 - Question

Baroness McIntosh of Pickering: To ask Her Majesty’s Government what plans they have to pause the Article 50 process.

Lord Callanan: My Lords, our position remains clear. We will respect the outcome of the referendum and will not revoke the Article 50 notice. We are committed to delivering on the instruction given to us by the people. As the Prime Minister has said, we will be leaving the European Union on 29 March.

Baroness McIntosh of Pickering: I thank my noble friend for the Answer. Both he and I have been Members of the European Parliament, and I understand  that the elections to it this year are used as an argument not to delay, as it would be inappropriate to field candidates. In the circumstances of there being an application to pause the Article 50 process, not least to enable us to pass the legislation required before 29 March, would he make the case to the Cabinet that we should apply for observer status for a number of Members of the European Parliament for the interim?

Lord Callanan: I thank the noble Baroness for her question, but I am afraid that I do not recognise the word “pause”. Pausing Article 50 is not an option. The UK could either revoke Article 50 or request an extension, but I am afraid that there is no remote control in DExEU with a pause button on it.

Lord Wigley: My Lords, is the Minister aware of the suggestion made by Mr Hilary Benn in Brussels yesterday that the logical time to implement the leaving of the European Union is at the end of the implementation period? Should not Article 50 therefore be adjusted to that end?

Lord Callanan: I did not hear that suggestion yesterday, but if we did not leave the European Union until the end of 2020 we would not have an implementation period, would we?

Lord Foulkes of Cumnock: My Lords, how are we going to get six Bills, hundreds of statutory instruments and scores of treaties through the House by the end of next month, even without having any recesses whatsoever?

Lord Callanan: I am tempted to reply that if the noble Lord was a little less obstructive in Committee, then we would not—

Oh!

Lord Callanan: Of course proper scrutiny is important, but raising a series of irrelevant points is not helping anybody. We are totally committed to the proper scrutiny of all the required and appropriate legislation, and we will do that.

Lord Hannay of Chiswick: My Lords, I wonder whether the Minister occasionally thinks that he is playing the role of the boy who stood on the burning deck whence all but he had fled, as numerous reports appear of members of the Cabinet saying that there will need to be an extension. Does he realise that when he stands at that Dispatch Box in about a month’s time and tells us that the Government have asked for an extension he will get a very warm welcome from many parts of this House?

Lord Callanan: I always get a very warm welcome from all parts of this House. As a representative of the Government, I can only tell the noble Lord what the policy of the Government is as set out by the Prime Minister, which is that we will not seek an extension and will leave the European Union on 29 March.

Baroness Ludford: My Lords, I agree with the drift of the question from the noble Lord, Lord Hannay. It is clear that the Government will have to seek an extension of Article 50; several Cabinet Ministers  support such an extension. Is not the attempt to corral MPs into supporting the Prime Minister’s deal—although she does not support it herself—by threatening a chaotic and disastrous no deal immoral as well as an abdication of government responsibility?

Lord Callanan: I do not agree that we are corralling anybody; we are attempting to convince Members of Parliament that the best way to avoid no deal is to vote for a deal. I am pleased that a number of the more sensible Labour MPs are also reaching the same conclusions—and one Liberal Democrat MP.

Lord Lilley: My Lords—

Lord Cunningham of Felling: My Lords—

Baroness Evans of Bowes Park: It is the turn of the Conservative Benches and then we shall hear from the Labour Benches.

Lord Lilley: My Lords, given that the other place threw out the withdrawal agreement largely because of the backstop, that the governing majority then deputed the Government to replace the backstop, that the EU itself has said that if we leave with no withdrawal agreement there will not be a hard border in Northern Ireland and that the EU never reaches an agreement until the last minute, is it not clear that we have to stick by 29 March and then it will give us alternative measures to the backstop before we leave?

Lord Callanan: I remind the noble Lord that as well as getting the meaningful vote passed by Parliament we need to legislate for it. Clearly, that is quite a challenging programme, but we will attempt it. The most important thing is to keep putting forward relentlessly the argument that the best way to avoid no deal is to vote for a deal.

Lord Cunningham of Felling: My Lords, since the Minister mentioned scrutiny, does he think that for departments to submit compendium statutory instruments covering multiple subjects replete with errors—in one case, a fatal error was referred back to the department and the department then said that it intended to withdraw the instrument but has not done so—expedites scrutiny?

Lord Callanan: It is difficult to comment on that specific example without seeing it. I hope that departments want to work with the noble Lord’s committee to make sure that the quality of statutory instruments is appropriate and that the appropriate scrutiny is applied to them. It sounds from what he says as though the appropriate scrutiny is being applied.

Lord Grocott: My Lords, is there not widespread agreement among leavers and remainers that one of the principal motives of the 17.4 million people who voted to leave was that they felt that Parliament and the elected politicians—in our case, the unelected politicians—were not listening to many of their grievances and concerns? Should we now, two and a half years after the referendum decided that we should leave,  propose a further extension of that period? Would that not simply reinforce and confirm the fears and concerns that leavers felt when they voted the way they did in 2016?

Lord Callanan: I can certainly say to the noble Lord that, on this side of the House, we are committed to listening to what the people told us in the referendum in 2016 and to implementing that result. I am sorry to say that a number of Members on opposition Benches believe that we should somehow ask the people to think again or to overturn that result, but the Government believe that the referendum result should be respected.

NHS: Accident and Emergency Departments
 - Question

Lord Hunt of Kings Heath: To ask Her Majesty’s Government what is their response to the assessment of the President of the Royal College of Emergency Medicine that removing the four-hour accident and emergency treatment target would have a “near-catastrophic impact” on patient safety in many emergency departments.

Baroness Manzoor: My Lords, I note the concerns of the Royal College of Emergency Medicine and assure it, and the House, that patient safety remains paramount in any NHS care setting. As I mentioned in the excellent debate that the noble Lord, Lord Hunt, introduced last week, the NHS long-term plan will reform urgent and emergency care, and NHS England’s clinical review of standards will report its interim findings in spring 2019. Until then, we are clear that existing core access standards will remain in place.

Lord Hunt of Kings Heath: My Lords, I am grateful to the Minister. She will know that, before the four-hour target was introduced, we had dangerously overcrowded A&E departments, very long waiting times and unsafe care generally. It is clear from the evidence that the chief executive of the NHS recently gave to a parliamentary committee that he wants the clinical standards review to get rid of the four-hour target under the guise of giving greater priority to the most urgent treatments. The problem with that is that most urgent treatments get priority already. There is a real risk that, if you let the four-hour target go, many patients will have to wait longer and longer. The royal college is concerned about patient safety. Is the answer not to invest in more beds and adult social care for frail, older patients and then get a more effective flow of patients through hospitals? In that way, the target could be met.

Baroness Manzoor: My Lords, the noble Lord is absolutely right: performance targets are important. However, we must ensure that the NHS is focusing on clinically appropriate targets. The clinical review of standards is considering standards for both physical and mental health. Following its interim findings, any recommended changes will be carefully field-tested  across the NHS before they are implemented. An impact assessment will be published and changes to the NHS constitution will be consulted on, as is legally required.

Lord Warner: My Lords, I remind the Minister that 12 years ago, when I was the ministerial enforcer of the four-hour A&E target, the royal college came to plead with me not to abandon it. Its arguments were not only the ones made by the noble Lord, Lord Hunt, but that this target had caused acute hospitals to reorganise their affairs much more efficiently. How will getting rid of the four-hour target impact on the Government’s drive to improve the efficiency of the NHS?

Baroness Manzoor: My Lords, I have already said that performance targets are important. The Academy of Medical Royal Colleges released a statement on 30 January, which said:
“Reviewing, updating and improving the clinical standards to ensure that they remain relevant and appropriate is sensible and overdue. We support an evidence based review that is driven by clinical considerations as to what is appropriate, that informs and promotes changes in service delivery where needed and involves wide input from all relevant parties … any review may suggest change or reinforce current measures”.
I could not have put it better myself.

Lord O'Shaughnessy: My Lords, the acid test for any waiting-time targets is the clinical outcomes they deliver. In 2017, NHS England recommended—and the department subsequently accepted—reforms to the ambulance waiting-time targets, but that took place only after a two-year clinical trial and an independent assessment by the University of Sheffield of the impact on patients of all kinds of severity. I suggest that, if there is to be movement in this area, it should proceed cautiously and only after following a similarly robust and objective process.

Baroness Manzoor: My Lords, of course I entirely agree with my noble friend. As I have said, there will be robust evaluation, monitoring and assessment before any targets are put in place.

Baroness Jolly: My Lords, there is no doubt that emergency departments are currently working at full tilt to care for their patients. I recently visited one that had totally reconfigured its workspace. By so doing, it had been able to operate much more efficiently, saving precious time. I believe that it had received grant funding to do this. How many emergency departments have done the same, with or without a grant?

Baroness Manzoor: My Lords, forgive me, I do not know the answer in relation to grants and will have to write to the noble Baroness, but she is right that NHS A&E admissions have been quite significant. Demand has increased. To put this into context, the NHS addressed just under 2,500 more attendances per day on average within the four-hour standard in 2017-18 compared with 2009-10, and 86.4% of patients admitted were transferred or discharged within four hours. Performance has improved since last year but we recognise that we have not hit the standard.

Baroness Symons of Vernham Dean: My Lords, is not the simple Answer to this Question that we need more nurses and doctors in our accident and emergency units? The real problem is that there are simply not enough there. I do not know when the Minister was last in an accident and emergency unit, but over the past 18 months or so I have been to three different hospitals six times and waited for hours with somebody who was extraordinarily ill and might well have suffered the ultimate consequence of his illness. It is simply not good enough to answer my noble friend’s Question in the way the Minister has done. This is a real issue and people are in great difficulty because we simply do not have enough nurses and doctors.

Baroness Manzoor: My Lords, I am very sorry to hear of the noble Baroness’s experience of A&E. Just to reassure her, I have been to the A&E department not very long ago so I know and understand the pressures on A&E departments. Indeed, I have worked in A&E departments so I understand the pressures on staff too. I reassure her that we are doing everything we can to ensure that there are more nurses, doctors and consultants working in A&E. I do not have the figures at hand, but we have more NHS consultants working in A&E than we have ever had.

Nissan in Sunderland
 - Statement

Lord Henley: My Lords, with the leave of the House I shall now repeat a Statement made by my right honourable friend the Secretary of State for Business, Energy and Industrial Strategy yesterday. The Statement is as follows:
“With permission, Mr Speaker, I would like to make a statement about Nissan. The House should know the background to the decision the company announced yesterday. In July 2016, the allocation decision for the next model of the Nissan Qashqai was about to be made and it was set to be awarded to a European plant other than Sunderland. Nissan had located in Sunderland in 1986, having been persuaded by Mrs Thatcher that the combination of British engineering excellence and tariff-free access to the European Union made Britain an ideal location. So it proved, and the Sunderland plant grew to be the largest car plant in the history of Britain. The firm invested nearly £3.7 billion into it and currently employs over 7,000 people with approximately another 35,000 in the supply chain.
The prospect of losing easy access to the EU market was the principal concern of the company at that time. It was clear that if Sunderland lost the Qashqai, which accounted for over half of its production, mostly for export, the medium and long-term prospects for a plant losing scale would be bleak. Determined not to see the 30-year success of this plant come to an end, we set out over the coming months a strong case for backing Sunderland. This centred on four areas, all of which were about highlighting the success of, and our strategy for, the British motor industry.
First, we would continue our successful and long-standing support for the competitiveness of the automotive sector, which has been available to all firms, for skills,  training the local workforce and innovation. The regional growth fund has supported over 3,000 companies, large, medium and small, since 2010, with £2.6 billion of public support. Some £335 million has been invested in the automotive sector via the regional growth fund since 2010. All proposals are independently assessed by the Industrial Development Advisory Board and subject to UK and EU rules.
In 2016, Nissan initially considered applying for a total of up to £80 million in support over nine years for skills training, research and development and environmental improvements, and it was eventually awarded £61 million—around £7 million a year over nine years.
The second commitment was that we would work with the automotive sector to ensure that more of the supply chain could locate in the UK in close proximity to manufacturing sites. Since 2016, as many noble Lords know, our automotive sector deal established, with the industry, an ambitious programme to do that.
The third was that we would make a strong commitment to research and development, particularly to the development of new battery technology and its deployment, and in connected and autonomous vehicles. Our joint industry-government £1 billion advanced propulsion centre R&D programme, along with our £250 million Faraday challenge, is putting Britain at the leading edge of battery technology and manufacturing, and we have introduced test beds for autonomous vehicles across the country. Indeed, the longest autonomous car journey in the UK will take place in November this year from the Nissan site at Cranfield to its site in Sunderland, covering more than 200 miles on public roads.
Our fourth commitment was that in our negotiations to leave the EU we would always emphasise the strong common ground that exists between the UK and other EU member states and pursue a deal that could ensure free trade unencumbered by tariffs or other impediments.
These commitments proved persuasive, as they have subsequently for investments by Toyota at Burnaston, BMW Mini at Oxford and PSA at Luton. Indeed, every competitive allocation decision since 2016 in this industry has gone to Britain. Although discussions had been around the Qashqai, Nissan proposed towards the end of the discussions to add a further model, currently produced only in Japan—the X-Trail—to Sunderland. On 27 October 2016, Nissan announced that both the Qashqai and the X-Trail would be built in Sunderland, securing the plant’s future and adding 741 new jobs.
Last Friday I was informed by Nissan that following a global review of its capital investment, future capital was needed to accelerate the shift in Europe from conventional to lower-emission vehicles. The Qashqai and the Juke will in future have petrol and plug-in hybrid variants made in Sunderland, and as a result, more capital will be invested in Sunderland than was originally planned in 2016. However, this was accompanied by a decision to maintain Japan as the sole production location for the X-Trail model, rather than to establish a new production line in Europe. The consequence of this is that the existing jobs in Sunderland will be maintained by the increased investment, but the  741 additional jobs that would have been created in Sunderland will not now be available. Nissan confirmed that production of the new Qashqai, Juke and Leaf will continue at Sunderland, and that the decision has no implications for the existing jobs at the plant.
Nissan also pointed out, as it has done consistently since 2016, that the risk of a no-deal Brexit was a source of damaging uncertainty. While I am pleased that the decision taken in 2016 to build the Qashqai and secure the Sunderland plant is unchanged, it is deeply disappointing to me and to the workforce to find that the extra jobs that would have come from the X-Trail will no longer be created. I told the House that I would publish the correspondence with Nissan at the time of its original decision, as soon as the company advised that it was no longer commercially sensitive. I have previously shared it with the then chair of the Business, Energy and Industrial Strategy Committee, but I have now agreed with Nissan that it is reasonable to publish it in full today. Colleagues will see that it sets out exactly what I told the House in October 2016.
Grant support for training and development and for environmental improvements were applied for and approved by the Industrial Development Advisory Board on the basis that both the Qashqai and the X-Trail models would be built in Sunderland. Given yesterday’s announcement, if the company seeks to participate in those industry funding schemes—as I hope and expect it will—it will submit new applications in the standard way and undergo a process of independent assessment.
I am disappointed that the new jobs associated with the X-Trail will not now come to Sunderland, but I am pleased that the plant will benefit from substantial new investment in the existing models and that the decision to continue with the vital investment in the Qashqai, Leaf and Juke, and the jobs associated with them, is unaffected. These decisions were made on broader business grounds, but Nissan has commented on the need for us to come together to resolve the question about our future trading relationship with the EU. I believe that its advice should be listened to and acted on, so that our automotive industry, which will undergo more change through innovation in the decade ahead than it has for most of the past century in areas such as battery technology and artificial intelligence, can seize the opportunities for Britain to be a world leader in state-of-the-art car making, providing great jobs and careers for hundreds of thousands of people during the years ahead. I commend the Statement to the House”.
My Lords, that concludes the Statement.

Lord McNicol of West Kilbride: My Lords, I thank the Minister for repeating the Statement made in the other place and must declare an interest as having bought a Qashqai for the very reason that it was made in the UK.
Nissan’s decision that the new X-Trail will no longer be built in Sunderland but instead in Japan is a bitter blow to the people of Sunderland and to the wider north-east. Close to 7,000 people are employed at the plant in Sunderland, with many thousands more along  the wider supply chain and support services. Although the X-Trail decision does not impact directly on the existing workforce, it sets a worrying trend for the future.
What is interesting in the Secretary of State’s Statement is that the Government, as far as we are aware, are trying to pursue an industrial strategy that looks to develop a co-operative partnership approach with such an important sector—an initiative that we support and something that this side of the House has been calling for for many years.
Of course, Brexit was not the only factor in Nissan’s decision, and it would be dishonest to suggest that the issue of diesel did not play a part in Nissan’s thinking. However—and this is important—Nissan for the first time, through its European chairman, Gianluca de Ficchy, has brought to the fore the uncertainty of Brexit as a key factor. He said on Sunday:
“The continued uncertainty around the UK’s future relationship with the EU is not helping companies like ours to plan for the future”.
That is a damning statement. The continued uncertainty is not helping.
What is more worrying is that the Government could help by ruling out the worst aspect of that uncertainty: that of a no-deal Brexit. The Government have the ability, the authority and the duty to do all they can to protect the interests of our businesses and economy.
Can the noble Lord confirm that the Government will actively engage with the trade unions and automotive manufacturers to protect what is now left? The truth is that the news of Nissan’s departure is not isolated and, in the coming months, more jobs and investment could well be lost in industries elsewhere across the UK. Only last week the Society of Motor Manufacturers and Traders announced that car production is down to its lowest level in five years: in total it has now slumped by 9%; and in the past year alone new investment has halved. What considerations are being given through the industrial strategy to ensure that other parts of the industry, such as Bridgend or Ellesmere Port, do not suffer in the same way?
Our automobile industry and wider manufacturing sector is in desperate need of assurances from the Government. They must finally rule out a no-deal Brexit, which in itself is the single most important decision they could take to remove that uncertainty.
Finally, why has no discernible progress been made on trade agreement negotiations, despite pledges otherwise? Where are we with the commitment that there will be no tariffs on British-made vehicles entering the EU?

Lord Fox: My Lords, I too thank the Minister for repeating the Statement. Just over a year ago Secretary of State Greg Clark launched the automotive sector deal. Things were a bit different then: in a confident, upbeat foreword, he said that,
“the government is investing in a new industry-led programme to raise the competitiveness of UK suppliers to match the best in Europe”.
Today’s Statement underlines how much things have changed. How can the Government claim to be raising competitiveness when uncertainty and delay make it impossible for businesses to plan and invest? Nissan’s  comments underline its struggle to plan ahead. Manufacturers do not even know what tariffs they will face at the end of next month, never mind the supply chain friction that will confront them. They are having to plan shutdowns in April to take stock of the situation. That is hardly raising competitiveness, and it is a key reason why confidence in the automotive industry is plummeting and, as the noble Lord on my right said, investment is halving.
One of the foundations of the Government’s industrial strategy was to create the best place to grow a business. It is clear that the abject confusion over Brexit and the surrounding discussions is weakening communities and the strategy. As the Minister said, we had confirmation yesterday that Nissan has decided not to build the X-Trail in the UK. However the Minister and the Secretary of State seek to dress this up, that is not a vote of confidence in the Government’s strategy. As the Secretary of State acknowledged, it injects uncertainty into an industry that is very important for the north-east—uncertainty over 7,000 direct-employment jobs and approximately 35,000 in the supply chain.
In the Statement, the Secretary of State was clear that Nissan had located in the north-east,
“having been persuaded by Mrs Thatcher that the combination of British engineering excellence and tariff-free access to the European Union made Britain an ideal location”.
So, when the chill winds blew in the year before last, the Minister acted fast and secretly to seek to insulate Nissan. In 2016, in order to reassure the company, the Government made a deal, which included public investment of around £60 million, as we heard, and was sealed in a letter that the Government moved heaven and earth not to publish. They cited commercial sensitivity as the reason—until this week, when publishing suddenly suited the Government. I have a number of questions about that letter.
First, what was commercially sensitive before that is not so now, particularly when the Secretary of State goes out of his way to explain that the funding surrounds the Juke and Qashqai ranges but not the X-Trail? That range will continue, so any commercial sensitivity should surely continue, too. Secondly, and perhaps more importantly, did the Government notify the EU competition authorities about their deal with Nissan? If not, why not? I note that in 2001, some £40 million of support for the production of the Nissan Micra was cleared through the EU. What was different about this support?
The Minister stated that the Government’s fourth commitment is to the,
“strong common ground that exists between the UK and other EU member states”.
I suspect that we would question that. He also said that Her Majesty’s Government would,
“pursue a deal that could ensure free trade unencumbered by tariffs or other impediments”.
There is no sign that the Prime Minister’s red lines will allow this to happen—and clearly Nissan no longer believes the Government, either. The reduced sector investment tells the same story.
The prime phrase in all this is “damaging uncertainty”. Faith is falling, even in the Minister’s own department. His colleagues in the other place sound increasingly  worried about what is going on and whether the right of his party will drive the country over a cliff. Mr Harrington has called no deal a “complete disaster”, while Mr Clark warned that a no-deal Brexit would be “ruinous” to the economy. Can the Minister tell us the adjective he would use to describe it?

Lord Henley: My Lords, before I answer any of the questions put to me by noble Lords, may I correct myself? I think I misread from my right honourable friend’s Statement, in that I suggested some 3,000 companies have been supported by the regional growth fund since 2010. In fact, the figure is 30,000. I apologise for that small error.

Oh!

Lord Henley: It is a smallish error of 90%. I have at least corrected it.
I welcome the comments of the noble Lord, Lord McNicol. I agree that this is a blow to Sunderland. It would have liked those extra jobs, but we have to remember that there are still 7,000 jobs in Sunderland that have been there for some time, largely because of the work originally done by my former right honourable friend Lady Thatcher when she, as Prime Minister, encouraged Nissan to come here. There are some 35,000 more jobs in the supply chain. This is good for Nissan, Sunderland and the whole of the north-east.
The noble Lord accepted that Brexit was not the only factor and that there were other problems in the whole automotive industry. Yes, there are. If the noble Lord would care to look—I recommend that the noble Lord, Lord Fox, does so—there are problems in the automotive industry throughout Europe in a big way. This is nothing to do with Brexit; it is because of changes we are making to regulation, changes to diesel, changes to the Chinese market and so on. I could go on. It is not all related to Brexit.
We have a world-leading and highly productive automotive sector, generating a turnover of some £78 billion—£6.5 billion GVA—and directly employing 65,000 people. Over the past two years we have continued to see further investment decisions. Britain has won competitive decisions on allocation of new car models for Nissan, Toyota, BMW and PSA Vauxhall, creating jobs in Sunderland, Derbyshire, Oxford and Luton. We still have an industry that we can be proud of and that can continue to do well.
The motivations for Nissan’s decision must be a matter for Nissan. It has to make decisions relating to its workforce where its plants are throughout the world. We accept that Brexit will be one small part of that and, as Nissan said, that it is still waiting for clarity on what the future trading relationship between the UK and the EU will look like. We therefore repeat our request for UK and EU negotiators to work collaboratively towards an orderly, balanced Brexit that will continue to encourage mutually beneficial trade. That is what Her Majesty’s Government will continue to do, as my right honourable friend the Prime Minister has made clear. We do not want a no-deal exit. As my right honourable friend said, we will work towards the meaningful vote as soon as possible.
The noble Lord, Lord Fox, also asked about the commercially sensitive nature of that letter, which he rather cynically suggested my right honourable friend the Secretary of State had released only now because it suited him. My right honourable friend said at the time, back in 2016, that it was commercially sensitive as a result of discussions with Nissan. Nissan made it clear that supplier negotiations were under way. Those negotiations have now completed and it is therefore a matter that can be released. As my right honourable friend made clear, we are more than happy to do so.
Finally, I was asked whether the United Kingdom Government notified the EU of the £61 million support. I can give that assurance. It has been given on many occasions. The grant award was fully compliant with EU state aid rules. Details of the award were shared with the EU and published on its transparency website.

Lord Forsyth of Drumlean: My Lords, I declare an interest as the owner of a diesel-powered Mini that was exempt from the congestion charge, but who, I am now told, will have to pay the congestion charge plus another £12 because of the emissions. This arises because of EU regulations.

Oh!

Lord Forsyth of Drumlean: Yes, it does. The EU was responsible. Under Gordon Brown’s Government we were encouraged to buy diesel cars and to put diesel fuel into them. The duty on the fuel was reduced. So to blame the manufacturers and Brexit for this problem is quite ridiculous. What are Jaguar Land Rover and Nissan, which have to plan in the long term for the production of their cars, to make of a regulatory regime that flips from being in favour of diesel one day to being against? Why are we surprised that Nissan no longer wishes to concentrate on producing diesel-operated vehicles in Europe and instead wishes to look to the future, to electric? Are the Government not to be congratulated on encouraging that investment in the north-east—an investment in the future, not in the past?

Lord Henley: I am very grateful to my noble friend for making those points and making them so well. I also declare an interest as an owner for the last 30 years of a whole series of diesel cars. Further, my wife—possibly inadvertently—bought a Volkswagen diesel at probably exactly the wrong moment, just before the scandal erupted in that field. I think we can say that changes to diesel regulations are a factor in decisions being made—decisions that the whole automotive industry has to make. It is also a factor for the Government to consider in deciding which new technologies we should support in future. I can give an assurance to my noble friend that the Government will continue, as he suggested, to support those new technologies.

Bishop of Lincoln: My Lords, I have been asked by my right reverend friend the Bishop of Durham, who is detained in his diocese, to ask the following question. While he recognises the promised protection of existing jobs, does the Minister recognise that Nissan’s X-Trail announcement will inevitably cause real worry for existing staff about the sustainability of their jobs,  both at Nissan and in the supply chain? Will the Minister say how Her Majesty’s Government intend to allay such concerns at local level and what they might do to encourage Nissan to invest more in the development of electric cars and autonomous vehicles?

Lord Henley: I am grateful to the right reverend Prelate for asking that question and for underlining the obvious concerns of all people living in Sunderland, Durham and the wider north-east, including the 7,000 workers at Nissan and the 35,000 people supported in the supply chain. We will continue to talk to all concerned; we want to allay those fears. We are very grateful that Nissan continues to be committed to that site. It has made enormous investments there over the last 30-plus years. As the right reverend Prelate stressed, we will also continue to make investments in R&D and new technologies in other fields. The automotive industry is changing, and what we have all been saying about diesel holds true. There will be a decline in diesel sales, but we hope to see a greater take-up in others.

Lord Hannay of Chiswick: My Lords, does the Minister not recognise that the real story here is that the Government—perhaps understandably—in 2016 gave an undertaking to Nissan that there would be no deterioration in its access to the European market, which they have proved unable to deliver? That is the real story, is it not?
The Minister referred to Baroness Thatcher and the role she played in getting Nissan established. I fundamentally and absolutely agree with that. I was the British Permanent Representative at the time. We had a lot of trouble because the French Government wanted origin rules to be applied to the production in Sunderland, which would have destroyed the case for investment there. Thanks largely to the late Lord Cockfield, that attempt was defeated. How sure is the Minister that, if we leave the European Union, the issue of origin rules will not arise again and affect the capacity of foreign investors in this country to export cars to the European Union?

Lord Henley: I am grateful to the noble Lord, Lord Hannay, for paying tribute to the late Lady Thatcher and for reminding us of the work of the late Lord Cockfield, whom many of us remember. As regards what will happen to the rules for the future, that will depend very much on negotiations. Those negotiations will continue. I very much hope that we get a deal that is suitable to make sure that this company can continue to flourish. I am sure that it will continue to flourish, and will continue to flourish in Sunderland, irrespective of what happens.

Baroness Quin: My Lords, I echo the concerns raised by the right reverend Prelate, but in its statement Nissan specifically mentioned the uncertainty created by Brexit. Another factor too is the recent conclusion of the EU-Japan trade agreement, which will make exporting from Japan to the EU and vice versa cheaper and simpler. Yet that is an agreement that we risk being excluded from after 29 March. Can Nissan and the people of Sunderland be assured that we will not have a no-deal Brexit that will make an already worrying situation even more serious?

Lord Henley: My Lords, again, I understand why the noble Baroness talks about the uncertainty in Sunderland and the rest of the north-east—an area that I remind her voted heavily back in June 2016 to come out. I particularly remember the vote on that night. A great many of us, including the noble Lord, Lord Adonis, will remember the moment when the vote took place in Sunderland. Anyway, we will continue to work, as I said, for the north-east and my right honourable friend made that clear. She also drew attention to the EU-Japan trade agreement. That gives us a model for what we want to work for. That is what we will do to secure the future of the people of Sunderland and I hope the noble Baroness will assist us in that.

Baroness Randerson: My Lords, the Government recently removed and reduced some of the grants for those buying hybrid and electric cars. Since then, sales of those vehicles have been very sluggish. That is yet another problem for the automotive industry to deal with. So will the Government undertake to restore incentives to purchase the cleanest vehicles and, at the same time, assist our automotive industry?

Lord Henley: My Lords, I will not discuss specific grants for any specific type of vehicle. I have made it quite clear that we are committed to supporting research and suchlike in new technologies for new vehicles because things of this sort are changing. Getting any grant structure right is obviously very difficult. One wants to avoid perverse incentives that push people down the wrong route—one thinks possibly of incentives made in terms of the pricing of diesel. The fact is that we no longer support diesel in the way that previous Governments did, and that has had a big effect on the market. But we are committed to seeing new technologies emerge in this area.

Lord Hamilton of Epsom: My Lords—

Lord Birt: My Lords—

Lord Hamilton of Epsom: No, it is not the turn of the Cross-Benches. We have just heard the noble Lord, Lord Hannay.
Does my noble friend accept that Nissan would have been absolutely mad to have gone ahead with the programme for the X-Trail when the whole of the market for diesel vehicles has collapsed? Does he accept that this is largely to do with the overreaction of European Governments, including our own, to the diesel emissions scandal, which was started by Volkswagen in Germany?

Lord Henley: My Lords, I am not going to allocate blame, particularly because, as I mentioned earlier, my wife was one of those who made the mistake of buying a VW just before the diesel scandal erupted. The fact is that there has been a concerted attempt to reduce the number of diesel cars, for whatever reason. For that reason, Nissan has to make hard-headed decisions about what cars it invests in and in which plants it should be investing.

Lord Birt: Like many of your Lordships, I have substantial and continuing experience of the real economy. The important story here is that Nissan is  not unique but typical. Routinely, I experience decision-makers in business and in the international investor community building Brexit into their day-to-day calculations. The result, as we have seen, is a massive loss in the value of our currency and the UK experiencing the lowest growth rate among the G7. Does the Minister agree with his Business Secretary that a no-deal Brexit would be ruinous?

Lord Henley: My Lords, I accept that a no-deal exit would be difficult. The point we are making is that we do not want no deal; that is why we are looking for a deal. Other than that, I have to say to the noble Lord that he paints a unduly gloomy picture. Things might be difficult for the automotive industry but, as I made clear, he will have seen that over the past few years—that is, since the vote in 2016—competitive decisions have been made in the automotive industry that have brought new car models to Nissan, Toyota, BMW, PSA Vauxhall in the UK, and that has created jobs in all parts of the country.

Lord Lennie: My Lords, other car makers in this country—Honda, Toyota and BMW—have pulled out from bringing models to this country. That demonstrates a lack of confidence in the future of manufacturing here, due in part to Brexit uncertainty. Nissan clearly does not feel that it can rely on the assurances given by the Secretary of State in his recently published letter that there will be free, frictionless trade between here and Europe. Why not?

Lord Henley: Things have changed. It is not solely to do with that. As other noble Lords have said, the whole car industry is going through a rather turbulent time. We only have to look at what has been happening in, for example, sales of diesels. For that reason, Nissan has to make difficult decisions. It has decided that it will go ahead with the X-Trail but will build it in Japan, no doubt for markets over there. Nissan is still committed to Sunderland. There are still 7,000 jobs there. There are still 35,000 more jobs in the supply chain. Things are not as bad as the noble Lord is trying to suggest.

Baroness Kramer: My Lords, as a Minister in the coalition, I had the privilege of visiting the Nissan plant in Sunderland, and I also visited most of the major Japanese car companies’ headquarters in Tokyo. As a consequence, I am very aware that British plants won the right to produce cars for these various companies by only the tiniest hair’s breadth, as a competition is run across the globe, and certainly across Europe, for each new piece of investment and for each new major production line. Does the Minister recognise that if he cannot give an assurance that there will be absolutely no increase in friction and non-tariff barriers, by definition those plants have no possibility of winning such competitions in future?

Lord Henley: My Lords, decisions on where to invest are very difficult. The noble Baroness is quite right to say they are made by a hair’s breadth. One of the reasons companies come to the UK is because they know that we have the right people in the right places. That is why they go to Sunderland and why we got  that investment in the right place. We should be proud of that. We will continue to seek other companies to come to invest in this country, like the companies I mentioned earlier have done. The noble Lord opposite suggested that BMW and Honda made competitive decisions that went against the UK. I am advised that that is not the case and no competitive decisions have gone against the UK in recent years.

Lord Tugendhat: My Lords, does my noble friend agree that, in an uncertain situation, one thing is certain—that if we go out of the EU without a deal, cars manufactured in Japan will be able to enter the EU on more favourable terms than cars manufactured in the UK?

Lord Henley: My noble friend is absolutely right about the recent trade deal agreed between the EU and Japan, and that is why we in the UK should seek to emulate deals of that sort. We are not seeking no deal; we are trying to get a deal. Let us all come together and try to get that.

Lord Lea of Crondall: Can the Minister confirm that he is saying that the rules of origin question does not arise in the deal currently proposed by the Government?

Lord Henley: I am not sure that I quite followed the noble Lord.

Lord Lea of Crondall: Can the noble Lord confirm that the origin rules problem does not arise in the present deal proposed by the Prime Minister?

Lord Henley: The origin rules problem is very detailed and complicated in terms of the percentage of any car that is manufactured on any particular site. If the noble Lord would like me to do so, I shall write to him in greater detail on that subject.

Baroness Ludford: My Lords, can the Minister inform us how many Brexiteer parliamentarians have been CEOs of major manufacturing companies, such that they purport to know better than the CEOs of, say, Honda or Airbus what the problems of Brexit are?

Lord Henley: I am not sure that that question really deserves a response.

Oh!

Lord Sterling of Plaistow: My Lords, in April last year the percentage of people buying diesel cars was 70.2%; it is now precisely 31%. That answers most of the questions today. Nissan is a very fine company. We have wonderful engineers in this country but if I were the chairman of Nissan today, I would have made exactly the same decision, which is most sensible. We will catch up when we have agreements in the future with countries such as Japan.

Lord Henley: I am very grateful to my noble friend for underlining what has happened to diesel sales, which is obviously a major factor in the decisions in this matter.

Lord Wigley: My Lords, the Minister in the other House made it clear that he was reinviting Nissan to submit an application for assistance on possibly different terms in order to overcome the difficulties that might now be facing the company. Can the noble Lord confirm that such an offer will be equally open to companies such as Ford, which is facing similar difficulties in Bridgend?

Lord Henley: My Lords, it is open to any company to apply for any funds that are available, as my right honourable friend made clear in the Statement, and that will be reviewed in the proper way, independently of my right honourable friend. I can tell the noble Lord that, of that £61 million, about two-point-something million pounds has been spent. It will be up to Nissan to make an application for the rest of it, although obviously it will not be needing it at the moment.

Lord Scriven: My Lords, as more decisions about where to make new models arise, is not the fear that car makers will look less favourably on a Britain that is outside the security of a large trade bloc, whatever the terms of an exit?

Lord Henley: I think that car makers will continue to look at the investments that they have already made and at the very great skills that are available in the United Kingdom. They will also continue to look at the R&D that we support for an industry which, as all noble Lords have been pointing out, is changing very fast with the decline in the demand for diesel but which is seeing growth in a great many other sectors.

Healthcare (International  Arrangements) Bill
 - Second Reading

Moved by Baroness Blackwood of North Oxford
That the Bill be now read a second time.

Baroness Blackwood of North Oxford: My Lords, it is a great honour to speak to the Healthcare (International Arrangements) Bill, on behalf of the Government, as my maiden speech—as my noble friend the Leader of the House put it so encouragingly when we first met, “straight in at the deep end”.
Before addressing the Bill in earnest, however, I hope your Lordships will indulge me as I record my profound thanks to noble Lords from across the House for their warm welcome over the past few weeks. I thank particularly my noble friend Lord Younger, Black Rod and the parliamentary staff who have so patiently guided me through the processes and procedures of this place. I offer special thanks to our wonderful doorkeepers, who have on more than one occasion rescued me from complete disorientation. I must also pay tribute to my two distinguished supporters: my noble friend Lord O’Shaughnessy, who is, I am sure  we all agree, a formidable act to follow, and my noble friend Lord Young of Cookham, one of our truly great parliamentarians, as well as a former Health Minister himself, of course. I am grateful for their continued advice and support. Last, but certainly not least, I put on record my sincere thanks, and those of my whole department, to my noble friend Lady Manzoor, who has so ably covered departmental business, responding tirelessly on topics ranging from tooth decay to sepsis to breast cancer, not to mention fielding a few lengthy SIs with grace and good humour.
I understand that it is a tradition to treat those of us who have come from the other place to a lesson or two in the nature of truly forensic scrutiny and expert debate. I humbly await my tutorial. However, I am sure the House will also appreciate that I remain very proud to have been elected by the constituents of Oxford West and Abingdon, and the outcome of the 2017 election was a great sadness for me. It was, of course, my home seat. My father was a cardiologist. He met my mother, then a scrub nurse, in an operating theatre in the Radcliffe Infirmary in north Oxford in 1973. On many a doorstep, constituents would tell me how fondly they remembered my father, who had treated or taught them, before proceeding to tell me in no uncertain terms that this did not mean that they would be voting for me.
It was a constant joy to represent such a research-intensive seat, where constituents were always so informed, engaged and unsparingly direct. I used to say that not only was I the only MP to get footnoted letters but I had to spend constituency days constantly at the ready for impromptu tutorials from world experts. Indeed, on one visit to the Rutherford Appleton Laboratory, a particularly keen particle physicist sequestered me in his office for a full 45-minute lecture on the nature of the muon—and, naturally, why STFC funding for his project should be maintained.
It is for this reason that when Garter Principal King of Arms asked me to choose a title, I had no hesitation in selecting north Oxford, the place where I have grown up physically and intellectually all these years. I have a suspicion that—although my previous roles as chair of the Commons Science and Technology Select Committee, Health Minister and chair of the Human Tissue Authority will of course prove valuable—my former constituents, who were so expert and so challenging, will actually have done the most to prepare me to serve your Lordships as a Minister in this Chamber.
I am mindful that the Companion states that maiden speeches should be short and uncontroversial. Short, perhaps, is within my gift, but I fear that my subject matter may diverge from strict convention. EU exit raises the collective blood pressure so notably that I have often wondered whether public health language should be developed for just such occasions. However, during its passage through the other place, the purpose of this Bill attracted cross-party support, and for good reason. However varied our views may be on our future relationship with Europe, we can all agree that access to healthcare is essential both for British nationals living in European countries and for EU citizens living in the UK.
In addition, as we look to a future increasingly defined by global mobility and chronic illness, it is the responsibility of government to consider, with all appropriate care and scrutiny, a more comprehensive approach to reciprocal healthcare. Your Lordships will know that current reciprocal healthcare arrangements give people retiring abroad more security, support tourism and enable essential mobility in our economy. The UK is party to a number of reciprocal healthcare agreements, which range from light-touch arrangements with Australia and New Zealand to the more complex EU reciprocal healthcare system.
I will briefly outline the latter: the UK funds healthcare for 180,000 pensioners and their dependants in the EU, living principally in Spain, France, Cyprus and Ireland. We fund needs-arising healthcare in the EU for UK tourists and students. The scheme is hugely popular. There are 27 million EHIC cards in circulation in the UK, resulting in around 250,000 claims each year. We directly fund healthcare for 10,000 posted workers and their dependants in the EU, EEA and Switzerland, and we fund around 1,350 UK residents to travel overseas to receive planned treatment in the EU, primarily maternity care.
The cost of EU reciprocal healthcare is £630 million a year, and at present we recover £66 million each year. This amount is increasing as the NHS gets better at identifying EU visitors and ensuring that the UK is reimbursed for care provided, but it is likely to remain a net spend because many more British pensioners go to Europe than the other way round. Unless there is a dramatic change in the weather across the continent, our models do not forecast that changing much in the near future.
It is clearly in the interests of the British public to ensure that reciprocal healthcare arrangements similar to those currently in place continue when we leave the EU, whether that happens through an agreement with the EU itself, as we very much want, or through bilateral agreements with individual member states in the unlikely event of no deal. For this reason, although this is a short Bill of just six clauses, it is vital. The powers in it are designed to ensure that, no matter the outcome of the exit negotiations, British nationals living in European countries and EU citizens living in the UK, not to mention tourists and posted workers, can have certainty and continuity of care. Should we wish to, the Bill would also allow us to strengthen existing reciprocal healthcare agreements with non-EU countries and to explore new agreements in future.
The Government are determined that we will reach a deal with the EU. With a deal, the withdrawal agreement will enable the continuation of existing reciprocal healthcare rules during the implementation period, and afterwards for people covered by that withdrawal agreement. But it is not a long-term arrangement and does not provide for the unlikely event that the withdrawal agreement is not concluded. In the event of no deal, the powers in the Bill would enable the UK to act swiftly to protect existing healthcare cover for British nationals in the EU, EEA and Switzerland, whether deals are made with the EU or  with individual member states. This is clearly undesirable but it is the job of a responsible Government to prepare for all scenarios.
In preliminary discussions with a number of your Lordships, I have been asked about the scope of the powers contained in the Bill. In this regard, I record my thanks to my noble friend Lord Blencathra and the DPRRC for the work that it has already done on this matter and for its characteristically robust report. I wrote last week to the committee in response to its report and have placed a copy of that letter in the Library.
So what, in detail, does the Bill do? There are three key elements. First, it seeks payment powers so that the Secretary of State can make payments for healthcare abroad. Expenditure by the Department of Health and Social Care relating to EU and other reciprocal healthcare arrangements is currently published in this place in the form of annual resource accounts in line with government reporting rules, and will continue to be so to ensure transparency. Secondly, it seeks discretionary powers to make regulations to give effect to healthcare agreements that are entered into. It is important to note at this point that any secondary legislation under this clause that amends primary legislation—Henry VIII powers—would be brought forward under the affirmative procedure, while other regulations that are expected to be technical and administrative in nature, such as replacing or updating the administrative forms, would take the negative procedure. Thirdly, the Bill seeks powers for authorised persons to lawfully share data to facilitate payments or treatments in a safe and effective way. Data would be shared in accordance with UK data protection legislation, including the Data Protection Act 2018.
It is important to note that the Bill does not affect the UK’s ability to negotiate or enter into international agreements; the power to negotiate and sign treaties is a prerogative power and always has been. It simply empowers the Secretary of State to implement agreements once they have been negotiated. The details of new reciprocal healthcare agreements will of course remain subject to negotiation and parliamentary scrutiny. I am aware that there has been some debate about whether CRaG powers are sufficient and that the Constitution Committee, so ably led by the noble Baroness, Lady Taylor, is currently conducting an inquiry into this very matter. I shall be interested to hear its conclusions.
I reassure the House that there can be no cause for concern that the Bill represents an attempt by the UK Executive to seize power from the devolved Administrations. The Department of Health and Social Care currently funds and arranges EU reciprocal healthcare for people from England, Scotland, Wales and Northern Ireland. We have been working with the devolved Administrations for some time now. I am delighted that we have received a legislative consent Motion from Scotland, and we will of course continue to ensure that we legislate for reciprocal healthcare in a way that fully respects the devolution settlements.
In particular, I note concerns raised in the EU Home Affairs Sub-Committee report debate in July, especially by my noble friend Lord Ribeiro, regarding  the importance of protecting healthcare in the island of Ireland. I reassure the House that the UK and Ireland are committed to protecting reciprocal healthcare rights fully and appreciate how important it is that UK and Irish nationals can continue to access healthcare when they live in, work in or visit the other country. We also want to maintain co-operation between the UK, Northern Ireland and Ireland on a range of medical issues, including planned treatment, public health and workforce, in both a deal and no-deal scenario.
Having set out the general purpose of the Bill in broad terms, my priority today is to hear from the House so I can begin what I know will be a robust process of scrutiny and strengthening of the Bill. Reciprocal healthcare arrangements enjoy broad public support and the Bill is designed to ensure that we can give British nationals living in European countries and EU citizens living in the UK certainty and continuity of care. It is designed to protect tourism and economic mobility. It is a Bill that looks to the future, giving us the ability to strengthen existing reciprocal healthcare agreements with non-EU countries and explore new agreements in the future.
I look forward to hearing the views of all noble Lords as we enter into the detail of the Bill. I will listen carefully and seek to engage as fully as I possibly can, whether with groups, by party or with individuals, so that we can ensure that proper scrutiny is given to the content and intent of the Bill. It is a necessary and pragmatic Bill. It is one that respects Parliament and the devolution settlements and looks to the future of reciprocal healthcare for generations to come. It is with that in mind that I commend this Bill to the House. I beg to move.

Lord O'Shaughnessy: I congratulate my noble friend on a truly outstanding maiden speech and say how delighted I am to see her in her place. Her speech has shown a glimpse of the many qualities that she will bring to this House: her intelligence, her humour and her commitment to public service. She did not mention that she is also a superb singer and flautist; perhaps today is not the day, but I hope she will give noble Lords the opportunity to hear and appreciate her musical skills at some point. I have dropped her in it now—not for the first time.
Not only did my noble friend give me the great honour of supporting her introduction yesterday but we had the opportunity to work together as Ministers for six months. During that time, she gave me one of the best pieces of advice I have ever had: watch your mailbag. It is an early warning signal when things are going wrong and problems need to be seen to. Because I was watching carefully under her very sage advice, I noticed more and more letters about problems with transvaginal mesh and sodium valproate. In many ways, they led to the review that my noble friend Lady Cumberlege is carrying out on medicine and medical device safety. That is the kind of impact that my noble friend has already had in her life as a Minister and she will go on to have an even more profound impact. She will know as well as I do that it is a huge privilege to hold the job that she does and I  hope she enjoys it as much as I did. I would also like to join her in congratulating my noble friend Lady Manzoor on holding the fort so ably in the last month.
The Bill before us is an incredibly important piece of legislation, for two reasons. First, it will give the Government the powers they need to continue our mutually beneficial reciprocal health agreements with EU member states. The advantages of these are already enjoyed by many of our citizens: 250,000 British tourists make medical claims every year under the EHIC card, 180,000 British pensioners live in the EU and hundreds of people take planned treatments paid for by the NHS but delivered abroad.
Secondly, as my noble friend said, as we become an independent trading nation once again, we want to be able to enter into similar arrangements with our trading partners. Lighter versions of our reciprocal healthcare arrangements already exist with Australia, New Zealand and some of the EU accession states. However, as we strike new trade and other agreements, it is absolutely right that the British Government make the most of the opportunities these present for our citizens to travel, work and retire abroad.
It is also a necessary Bill because the powers on which we base our current ability to strike reciprocal healthcare agreements derive from EU law, specifically EU Regulations 883 and 987. These will become inoperable once we leave the European Union, however that should happen. At the risk of disappointing the noble Lord, Lord Foulkes, who will speak directly after me, this legislation does not fit into his category of the no-deal planning which he believes to be a waste of time and money. It is quite the opposite: we need these powers for any deal that we strike with the EU, whether the one agreed by the PM, the one that is official Labour Party policy or any other that might emerge.
For these reasons I strongly support the Bill, which will not come as a surprise since I was the Minister responsible for it until the end of December. However, I also believe it is one that all noble Lords should support because of the benefits it will bring to British citizens. Critically, this point is recognised by the Scottish Government, not the greatest friend of either this Government or Brexit but who have exceptionally agreed to a legislative consent Motion for the Bill.
Nevertheless, as this debate will show, and as debates on the Bill in the other place and the report of the DPRRC have brought out, there are some significant questions about the legislation that must be dealt with. The first, which was the subject of Labour Front-Bench amendments in the Commons, is to do with creating specific reporting requirements on any spending involved in new reciprocal deals. I can understand the desire for such information but there is already a robust annual reporting process, which is used today and which covers reciprocal health and other departmental spending, that allows for scrutiny by both Houses of Parliament as well as by the Public Accounts Committee and the NAO. It is of course also covered in the DHSC’s annual report. If the current procedures are good enough while we are still members of the EU, and if our intention is by and large to recreate the same kind of relationships, then I see no good reason to change this approach.
The second question is the criticism, made forcibly in the DPRRC report, that there are too few constraints on the powers that the Bill gives to the Secretary of State. I always take the opinion of the committee very seriously but in considering its view, it is essential to consider not only the intent of the Bill but its reach. On intent, as I have said, the overall aim is to agree reciprocal deals that are similar to those we currently enjoy with the EU and to strike new, more sophisticated deals with our trading partners. However, with our new-found freedoms it is likely that we will want to consider additional, yet to be anticipated approaches.
The Bill clearly ought to be flexible enough to accommodate this, because it is simply impossible to determine in advance what might be desirable as we agree new trade deals and other international agreements. On its own, I accept that this might be a cause of concern, until one realises that the reach of the Bill is in fact limited because the powers it confers on the Secretary of State can be used only within the scope of an international treaty, which will always be subjected to detailed scrutiny and approval in Parliament. In that sense, the Bill is essentially concerned with giving the Secretary of State implementation powers under the broader aegis of an international treaty, each of which will require parliamentary approval. I believe that this ought to give noble Lords reassurance that the powers in the Bill cannot be misused.
Thirdly, there is the issue of regulation-making powers and affirmative procedures, as already mentioned by my noble friend. It is somewhat ironic to find those who vehemently oppose the UK’s departure from the EU promoting this cause, given that our membership gives the UK Parliament no say whatever in whether EU law should be implemented, but let us not dwell on that inconsistency. The approach outlined in the Bill, using the affirmative procedure only for changes to primary legislation, is entirely reasonable and consistent with other legislation. Nevertheless, my noble friend the Minister will no doubt want to reflect on the findings of the committee and the views of the converts to the cause of taking back control as we move forward.
Finally, there is the issue of data security. The exchange of data is essential to any sophisticated reciprocal healthcare agreement, which is why it features so prominently in the Bill. But as my noble friend the Minister will know—she understands the data issue deeply—it is of great concern to the public, so I hope she will be able to reassure the House that we would enter into such data-sharing arrangements only if the highest standards of security can be met.
I will end by talking about what is at stake here. It is not just our citizens who support the continuation of reciprocal healthcare arrangements with our European neighbours; so do the citizens and Governments of those countries. During my time as a Minister, I went to several EU health ministerial meetings and met most of my European counterparts. As your Lordships might imagine, that involved some interesting and occasionally challenging conversations. But without exception, those countries want to continue the reciprocal healthcare agreements once we leave the EU. Indeed, while my job in those meetings was to present the case for a deep and special relationship with the EU on  health and other issues post Brexit—sometimes receiving polite nods and the line “the Commission leads on negotiations”—on reciprocal healthcare, several Ministers initiated discussions with me about how we could continue our partnership in future. This is partially about financial self-interest—the UK is a net contributor to EU member states through the current arrangements—but it also reflects a profound and historical commitment, in some cases dating back pre-war, to partnership and co-operation.
What this Bill represents is not only the chance to do the right thing for British citizens and patients, but also to extend the hand of friendship to our European neighbours and our partners around the world as we leave the European Union. That is a laudable cause, which I hope will draw support from noble Lords across the House today.

Lord Foulkes of Cumnock: My Lords, before I revert to my usual mode of careful scrutiny, I offer a sincere triple congratulations to the Minister: first, on her elevation to this place—she did a great job in the other place and we welcome her here—secondly, on her appointment as Minister; and thirdly, as the noble Lord, Lord O’Shaughnessy, said, on a really excellent maiden speech. She comes to us with a great reputation and, I understand, undoubted ability. Given this Bill, she is going to need a lot of that.
This is an astonishing piece of legislation. With respect, relatively few have understood the wide and serious implications—and the consequences—of this Bill. I am astonished that the Scottish Government have not seen the implications, and that some of my colleagues down in the other place have not yet seen them. Thankfully, our Delegated Powers and Regulatory Reform Committee has understood it and produced a very good report. I am particularly grateful to the noble Lord, Lord Blencathra, and his colleagues for it. It particularly refers to Clause 2. I have read a few reports in my time, but this is really quite devastating. I will quote from it:
“We draw attention to clause 2 of the Bill. If the reason for the Bill’s introduction is to protect British citizens if a ‘no deal’ scenario affects current reciprocal healthcare agreements with other EU countries”,
which it does,
“clause 2 of the Bill goes considerably wider. It allows the Secretary of State to make regulations”,
first,
“in relation to the payment by the Secretary of State of the cost of all forms of healthcare … provided by anyone anywhere in the world”—
astonishing—secondly,
“for and in connection with the provision of any such healthcare, provided by anyone anywhere in the world”,
and thirdly,
“to give effect to international healthcare agreements”.
It goes on to say:
“Clause 2 has a breath-taking scope. Indeed, the scope of the regulations could hardly be wider … There is no limit to the amount of the payments … There is no limit to who can be funded world-wide … There is no limit to the types of healthcare being funded … The regulations can confer … powers and duties … on anyone anywhere … The regulations can delegate functions to anyone anywhere … the regulations can amend or repeal any Act of Parliament ever passed”—
astonishing powers—and that:
“The Government say that clause 2 ‘enables the Secretary of State to address essential matters relating to healthcare abroad’. But the powers in the Bill go much wider than essential matters”.
It continues:
“All regulations made under clause 2 are subject only to the negative procedure”.
My noble friend Lord Adonis knows that that is a very—

Lord Adonis: Dangerous.

Lord Foulkes of Cumnock: —dangerous procedure, but also that there is very scant scrutiny in that procedure. The report states that the regulations are subject to the negative procedure,
“save where they amend primary legislation. If, without such amendment, the Secretary of State wished to fund wholly or entirely the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia, the regulations would only be subject to the negative procedure”.
It is really quite astonishing. That is a great report. I could not have done better myself.

Lord Adonis: Why Arizona?

Lord Foulkes of Cumnock: Anywhere. That is just a random choice. It could be Texas or Alaska—it would be a bit more expensive in Alaska.
That is a really wide provision. Before we finally pass this Bill, Clause 2 needs drastic amendments. I say to my noble friends on the Labour Front Bench, to my friends—and they are my friends—on the Liberal Democrat Front Bench, to members of the committee and to Cross-Bench and Conservative Members that I hope that we will see those amendments in Committee. I hope that we will properly scrutinise this Bill because it has not yet been done.
The inevitable consequence of the Bill is to replace a system that works well and gives peace of mind to many thousands of British citizens with completely unnecessary worry and uncertainty. Whatever the Minister says, it will be about damage limitation. Of course, the worst of all options is no deal, which would immediately remove the guarantees which British citizens living in the European Union and European Union citizens in the UK currently take for granted. That the no-deal option is still on the table is an indictment of the Government and their failure to face up to the consequences of their attempts to appease the hard right of the Tory party. All we are offered by the Bill is uncertainty and “Trust the Minister; everything’ll be okay”. The Bill allows her or him to do just about anything, but instructs them to do absolutely nothing. That is a recipe for uncertainty.
Let us first take the S1 scheme, which is central to this debate. This allows individuals from one EEA member state to receive healthcare in another, with the cost of that care met by the state in which the patient would ordinarily reside. Some 190,000 UK pensioners living in the European Union or the EEA are currently registered for this scheme. What happens to their rights if we leave without a deal? Many would have to return to the United Kingdom in fear of facing astronomical health bills elsewhere. That would affect not only those currently benefiting from the S1 scheme but the NHS, which would have to take the strain of  the increase in number of elderly returning citizens. A report by the Nuffield Trust estimated that if expats returned in large numbers, we would require 900 extra beds and over 1,000 more nurses. Where would they come from? It certainly would not be from European Union countries, since the Government are already busy telling them that they are not really welcome in the United Kingdom.
That brings me to the EHIC. I hope that everyone has it. I have mine. Every time I go abroad, I take it with me. We rely on it to make travel abroad a possibility. At present, 27 million active United Kingdom EHICs are in circulation. They are used to pay for around 250,000 medical treatments each year. Incidentally, I tried to find out how to apply for or to renew an EHIC. I put “European health insurance card” into the Google search. I pressed it and what did I get? “This page cannot be displayed”. We cannot find out. Can the Minister tell us why the Government are not allowing people access to the EHIC? Is it in anticipation of a decision relating to it? Is it in anticipation of a deal or no deal?

Lord Adonis: “Alternative arrangements”?

Lord Foulkes of Cumnock: If we lose this right, the only ones celebrating will be the insurance industry. When I tweeted something about the EHIC no longer going to be available, lots of people tweeted back saying, “Ah, but we can get travel insurance”. That is all right if you are reasonably wealthy, but for ordinary people who have struggled just to get enough money to go abroad, it is an extra cost.
These arrangements are the cornerstones of the freedom of movement principle which the European Union rightly sees as its own but which the UK Government, sadly, are hell-bent on opting out of. There are those who point to the deal that the EU has with Switzerland at present. It is true that, under the Bill in the event of no deal, we would be able to implement new bilateral agreements with European Union states, Norway, Iceland and Switzerland. This would be lengthy and costly, ultimately leaving the European Union without reciprocal arrangements for an unknown period. I raised this with the Minister and her counterpart in the Commons when they kindly held a briefing on it. They would be scrabbling around the European Union—indeed around the world—negotiating bilateral agreements. If the Health Secretary is as successful in doing deals as the Trade Secretary, there are going to be an awful lot of sick Britons scattered around the world for years to come.
We need to approve the Bill—of course we do; the Minister said it; the noble Lord, Lord O’Shaughnessy, said it—but with some appropriate and significant amendments to Clause 2. Without it, the Secretary of State will not even be allowed to do the deals which will protect British citizens abroad. However, there should be no doubt at all that the very good arrangement which we have at present is being replaced by, at the very least, an inferior one. It remains to be seen if the operative word really is “inferior” or if, as I fear, “disastrous” is a better way to describe what we are facing if we go for no deal. I hope everyone in this House will do everything they can to ensure that that  does not happen. For the health of British expatriates and of those of us who travel overseas, it is vital that we do so.

Lord Marks of Henley-on-Thames: My Lords, I join the noble Lords, Lord O’Shaughnessy and Lord Foulkes, in welcoming the noble Baroness, Lady Blackwood of North Oxford, to the House and to her post. I congratulate her on making an excellent maiden speech. I hope she will forgive me when I admit to spending a great deal of time in her erstwhile constituency and to having campaigned there in the last two general elections—so I may have played a very small part in her elevation to your Lordships’ House.
Although I thoroughly enjoyed the Minister’s speech, particularly the passages about Oxford, she did not—perforce, I accept, as did she—comply with the tradition that maiden speeches ought to be uncontroversial. I oppose the Bill in its present form. I am conscious of the fact that it has passed through the House of Commons unamended and that the report of the Delegated Powers and Regulatory Reform Committee was, unusually, produced on 15 November, before Committee in the other place. Nevertheless, regrettably, the Committee’s report was taken insufficiently seriously by the House of Commons. Sometimes the lack of scrutiny of departures from our constitutional arrangements is frankly unforgivable.
Of course, noble Lords across this House much want to see arrangements for reciprocal healthcare with member states of the EU, the EEA and EFTA continuing as closely as possible to their present form. Indeed, one of the great risks of the calamitous decision to leave the European Union is 27 million UK EHIC card holders, and 180,000-odd UK state pensioners living in the EU who benefit from the S1 scheme, risking the loss of their current rights to reciprocal healthcare.
The Explanatory Memorandum and the Minister say that the Bill has been introduced as a result of the decision to leave the EU and is intended to respond to all possible outcomes of EU exit with new reciprocal healthcare agreements. However, the Bill confers on the Secretary of State exceptional and untrammelled powers that are utterly objectionable. Furthermore, as I will argue, the breadth of these is entirely unnecessary to achieve what is needed to enable satisfactory reciprocal healthcare arrangements to be made on Brexit.
I shall start by turning to the proposed powers. Clause 1 states:
“The Secretary of State may make payments, and arrange for payments to be made, in respect of the cost of healthcare provided outside the United Kingdom”.
There is no limit on the amount of such payments. There is no limit on the type of healthcare to be provided. Indeed, Clause 3 says that,
“‘healthcare’ means all forms of healthcare provided for individuals, whether relating to mental or physical health, and includes related ancillary care”.
There is no geographical limit on where it is to be provided: the power is worldwide. The additional definition of “healthcare agreement” covers providing to other  countries healthcare without limit within the UK, and possibly at UK taxpayers’ expense. Clause 2(1) cures none of these deficiencies.
Worse still, Clause 2(2) is entirely unlimited. The regulations may do any of the things provided in subsections (a) to (i), “for example”. So logically they may also do anything else. The Secretary of State may specify, in regulations, levels of payments and their calculation; classes of beneficiaries; types of healthcare to be provided; set-off arrangements; and reimbursement levels, which may include caps. I interpose that this is particularly important because the Secretary of State may decide who pays back what—whether citizens, international organisations, states or the UK Government. The list goes on with processes, appeals, discretion and an unlimited power to boot to delegate any functions under the clause.
Further, the Secretary of State may, in an exercise of absolute power under Clause 2(3),
“give directions to a person”,
and under Clause 2(4),
“may vary or revoke directions”,
in relation to any function. The Bill does further violence to our constitutional arrangements by providing, at Clause 5(3) and (4), that:
“Regulations under section 2 may amend, repeal or revoke primary legislation—(a) for the purpose of conferring functions on the Secretary of State or on any other person (including conferring a discretion);—
or—
“(b) to give effect to a healthcare agreement … Regulations under this Act may amend, repeal or revoke retained EU law”.
These are Henry VIII powers in terms that would have made even that Tudor monarch blush. But we should remember that Henry VIII powers take their name from the Statute of Proclamations 1539, which enabled the King to govern by decree without regard to Parliament. In the context of a process whereby Parliament is supposed to be taking back control, these powers fly in the face of parliamentary sovereignty.
The House will by now be familiar, from speeches by the noble Lord, Lord Foulkes, and others, with the conclusion of the Delegated Powers and Regulatory Reform Committee:
“Clause 2 has a breath-taking scope. Indeed the scope of the regulations could hardly be wider”.
I had the honour of serving on that committee under the distinguished chairmanship of my noble friend Lady Thomas of Winchester. Our discussions were entirely non-partisan and our reports generally—indeed, I think always—unanimous. They were carefully considered. We were extremely well staffed and our recommendations were almost always accepted and implemented by the Government.
The principles we applied were well known and well understood. First, we considered whether a delegation to a Minister was proper and appropriate. Only if it was would we move to the second stage of considering the proposed level of parliamentary scrutiny. Henry VIII powers were to be severely limited to those cases where the need for them was fully explained and justified.
The passage of legislation around Brexit has seen many arguments about the use of Henry VIII powers, but I regret that the Bill persuades me that the Government have learned nothing. As we are forced into an unholy rush to get Bills through, our constitution takes second place to political expedience and face saving. An important passage in the committee report is at paragraph 11:
“All regulations made under clause 2 are subject only to the negative procedure, save where they amend primary legislation. If, without such amendment, as quoted by the noble Lord Lord Foulkes, the Secretary of State wished to fund wholly or entirely the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia, the regulations would only be subject to the negative procedure. Of course, these examples will not be priorities for any Secretary of State in this country. But we judge powers by how they are capable of being used not by how governments say they propose to use them. The fact that the powers could be used in this way suggests that they are too widely drawn”.
That last reference to the potential use of powers is an important quote from paragraph 20 of the committee’s guidance to departments, published in 2014:
“If the government has in mind a particular proposed exercise, it is helpful for the Committee to be told of this. But the Committee will judge the power by reference to what could be done under it by the current or any future government and not only what the current government say they intend to use the power for”.
That principle is what makes the Government’s Explanatory Memorandum unhelpful and the caution of the committee essential. I am afraid that the Minister’s speech and that of the noble Lord, Lord O’Shaughnessy, failed to grapple with this issue. The Minister seeks to reassure the House while she urges the House to accept the possibility of what is unacceptable. I accept the committee’s view that its examples of Arizona and Australia are extreme. However, we have a Government who are, in their own words,
“determined to make a success of Brexit”,—[Official Report, Commons, 10/7/18; col. 929.]
and resolutely opposed to our staying in a customs union with the EU, so as to be free to make trade deals across the world. May it not be that, in their zeal to reach such trade deals, given the difficulties of so doing, the Government could offer in exchange for trade deals health agreements to third countries on terms that Parliament might consider unsatisfactory were it allowed to consider them properly?
The EU’s new economic partnership agreement with Japan, mentioned earlier by the noble Lord, Lord Henley, demonstrates how difficult new trade deals may be. Nor should we forget either that the ill-fated TTIP attracted so much opposition in the United Kingdom precisely because it opened up our healthcare market to American competition, to the extent that the Conservative Government in 2016—

Lord Framlingham: The noble Lord is putting a most peculiar slants on some aspects of this legislation. I am following this very carefully. Is there not a good case for being perhaps overgenerous and having a wide scope in this area to ensure that nobody misses out, rather than being too precise and risking the chance that people will suffer as a result?

Lord Marks of Henley-on-Thames: No, I do not, and I regard that view as profoundly dangerous. The reason is that when we need arrangements that justify  legislation, we can specify what legislation we need. As I will seek to go on to show, I believe that the arrangements that could be put in place by the Bill, were it tightly drawn and properly amended, could enable all outcomes from our exit from the European Union to be catered for by reciprocal healthcare arrangements in a way that is constitutionally acceptable—as I do not believe this is. As for giving too much ground and being too generous, that is a slippery slope indeed to allowing the Executive to take undue and unacceptable power from Parliament.
I suggest that it is not unrealistic to foresee a Government seeking to enter into healthcare agreements that would be unfair to the UK and unwelcome to many. The Bill would make that possible by unamendable regulation, possibly passable by the negative procedure.
So what should happen? If we secured a withdrawal agreement, an implementation period to the end of December 2020 and any extension of such a period would ensure that we continued reciprocal healthcare arrangements substantially as at present. That is what the Minister wants; I accept that she wants it, and that many in the Government want it as well. But we cannot guarantee that we are going to get it, and the Government have resolutely set their face against ruling out a no-deal agreement.
There is presently no reason whatever to make fresh statutory provision for any extra healthcare agreements outside the EU, the EEA and Switzerland. Such arrangements can be made if relevant, when necessary and authorised by a proper and detailed statute—nothing to do with Brexit—just as they could have been made at any stage over the past few years.
The need now is for provision in the event of no deal. I suggest that in that ruinous event, the only arrangements that we could practically make for continuing reciprocal healthcare would be the same as, or broadly comparable to, the existing arrangements. The noble Lord, Lord O’Shaughnessy, explained that, from his discussion with other European Health Ministers, he regards it as likely that they would want similar arrangements. Similar arrangements might be possible. Something completely different would, I suggest, be entirely impractical.
It might be necessary to agree such arrangements on a bilateral basis with individual states. It might be possible to make such arrangements on a multilateral basis. For such purposes, I accept that legislation is necessary. An appropriate Bill could be drafted without undue difficulty. Indeed, as the Bill is here and has passed through the House of Commons, I accept that amendment of it, while demanding, might be possible. The powers of the Secretary of State to introduce a new scheme and make equivalent agreement arrangements with other member states, whether on a bilateral or multilateral basis, could be carefully drafted in a fashion that was appropriately limited and would command the confidence and respect of this House.
However, I have no hesitation in saying to the House that the Government must come back in Committee with amendments that limit this Bill to that achievable and justifiable purpose. To press ahead with it in its present form for fear of a no-deal Brexit would be unconstitutional and improper. The Government must think again.

Lord Kakkar: My Lords, I join other noble Lords in congratulating the Minister on her excellent maiden speech and the very thoughtful way in which she introduced this important Bill at Second Reading. In so doing, I declare my interest as Professor of Surgery at University College London and chairman of UCL Partners. I should add that my noble friend Lord Patel, who regrettably cannot be in the Chamber at the moment because he is chairing a meeting of your Lordships’ Science and Technology Committee, very much wanted to participate, shares many of the views that I shall put to your Lordships and has committed to participate actively in further consideration of the Bill by your Lordships.
As we have heard, the Bill is vital. The current reciprocal healthcare arrangements that exist as part of our treaty obligations with the European Union provide for 180,000 UK pensioners living in other EU nations to be secure in the knowledge that they have access to all their healthcare needs. This is a very important consideration, because we know that, with advancing age, there is a greater demand on healthcare resource. The anxiety that attends any uncertainty about access to healthcare, particularly for those with chronic, long-standing conditions, through arrangements that have been well tried and tested, is clearly unacceptable and something with which no United Kingdom Government would ever wish to be associated.
Equally, we have heard about the 27 million European health insurance cards that have been issued and the important opportunities the scheme provides for students and tourists to be able to travel through the European Union and have their immediate healthcare needs addressed at times of emergency—again, avoiding uncertainty. Then there is the small number of our citizens—the figure of 1,300 was mentioned by the Minister—who are able to avail themselves of treatments and interventions on mainland Europe as part of their healthcare needs as a result of the reciprocal healthcare arrangement. That should not be underestimated.
The question is: with the proposed departure from the European Union, how can Her Majesty’s Government best achieve continuity and certainty in an area that affects the lives of so many of our fellow citizens? Clearly, of course, the best opportunity would be to ensure that the current arrangements of reciprocal healthcare are continued in any agreement that is finally settled with our European partners. If that is not entirely possible at the moment, how should Her Majesty’s Government make arrangements to deal with what the consequences may be? Both in the other place and so far in this debate, we have heard that some form of Bill, accurately and purposefully drafted to achieve those objectives, is essential. In the other place, it was agreed by consensus that impediment should not be put in place of achieving something, by way of the Bill’s purpose, prior to 29 March; that should be the guiding principle in your Lordships’ House.
Having said that, your Lordships must address the important issues raised both in the debate so far and in the Bill’s consideration in the other place. The first concerns data sharing—a hugely sensitive matter when  it comes to healthcare data. At the moment, we are confident that, through the Data Protection Act 2018, the position on data protection adopted in the United Kingdom is consistent with that adopted across other European community/EEA nations. Of course, that is reassuring because this framework ensures that we share healthcare data on the same basis, with the same security and with the same confidence.
However, moving forward, it is important for Her Majesty’s Government to be clear that, if at the time of our EU departure there is any divergence away from the recognised data protection standards, there will be an opportunity for this House and the other place to understand what it will be, and that the protection of our citizens and their sensitive healthcare data is maintained. Indeed, as the Bill proposes the opportunity to negotiate broader reciprocal healthcare agreements beyond the current European Economic Area, it is important for your Lordships’ House to understand how those data protections will be maintained if Her Majesty’s Government decide to avail the Bill—eventually to be an Act of Parliament—to negotiate those agreements. How will data security and data protection be ensured across a range of jurisdictions that do not currently sign up to the protections we enjoy as part of the European Union?
Clause 4(6) outlines the authorities that might benefit from data sharing, including HMRC, Treasury Commissioners and so on. It must be clear about on what basis sensitive healthcare data will be shared and the purpose of that sharing with other elements of the state beyond those directly concerned with the delivery of healthcare. I can imagine that the reasons are very good in terms of understanding, for instance, the status of a pensioner living elsewhere in the European Union by reference back to their time as a resident in the United Kingdom. As part of scrutinising the Bill, it will be essential to understand the basis for that.
Noble Lords have asked important questions about the scrutiny associated with the powers in the Bill and, indeed, the resultant statutory instruments and secondary legislation that will be generated by necessity. In this regard, there are important constitutional questions, as well as important practical and clinical ones, about how your Lordships and Parliament in general can satisfy themselves that the regulations to deal with the procedures and practical implications of the powers that the Secretary of State will need to exercise will be scrutinised. I will give an example, if I may. Let us say, for instance, that a settled UK pensioner living somewhere else in the European Union currently receives healthcare and treatment of some form for a chronic condition. As I understand it, under the provisions of the Bill, the Secretary of State will have to make provision for the continued payment of that care. But what happens if that individual receives a therapeutic intervention that is standard and part of a carefully considered and accepted protocol for treatment—let us say cancer therapy with a biological agent—in the other European country, but, in our own healthcare system, NHS England through to the National Institute for Health and Care Excellence has taken the view that it should not be supported? How will the administrative and procedural arrangements that flow from this legislation be crafted to deal with that situation? There might  indeed be considerable unhappiness after the Bill passes if our fellow citizens living in the European Union will have an intervention available to them that we do not believe is necessarily appropriate and should not be available in our own country.
How will the development of that administrative tool be scrutinised by Parliament? It would be seen by convention as a procedural and administrative matter. Under those circumstances it would be subject to the negative resolution procedure, but it has severe and important implications and the benefit of active and thorough scrutiny would help all parties. That is an important issue.
I have one final point. We have heard discussion about the Secretary of State’s powers to make new international agreements beyond the European Union and the European Economic Area and how those might attend future trade agreements. How do Her Majesty’s Government propose to extend the potential opportunities that will flow from the Bill to other jurisdictions beyond those where we have reciprocal healthcare agreements? How will that choice be made? The delivery of healthcare in our country through the National Health Service is a matter of social equity. How can we reassure ourselves that all individuals in our country will have access to the same standard of healthcare and the same opportunities to achieve that access? It cannot be argued that providing reciprocal healthcare for our fellow citizens living in the European Union is anything other than an obligation under a broad treaty, but in the future, when there might be bilateral agreement between certain countries and not others, how will we be able to argue that pensioners living in one jurisdiction and not the other should benefit from the Bill’s opportunities? There might be a simple answer, but as we take forward this legislation and decide to broaden it beyond the current European Economic Area, that might be something that your Lordships need to pay attention to.

Lord Lansley: My Lords, I join colleagues across the House in welcoming my noble friend to this House and to her new position. I had the privilege to serve in the other place with her. I know how highly regarded she was for her work there and in her constituency. As a former Member for South Cambridgeshire, I think it is very like north Oxford as a place. I had the pleasure of campaigning with my noble friend in Abingdon and had something to do, in a very small way, with getting her elected in the first place. The Commons’ loss is our gain. We are delighted to have her with us. I know that the Department of Health and Social Care is delighted to have its former Minister back.
I very much share the view of my noble friend Lord O’Shaughnessy, who was instrumental in the Bill’s composition, that it is very important and necessary. It is important that we do not alarm people about the circumstances of their healthcare. We should make it clear, if we can, that we are all setting out to try to ensure that there is continuity in the existing arrangements for reciprocal healthcare across the European Economic Area. We might not be in a position to guarantee that because the withdrawal agreement might not be implemented. If it is, that will be all well and good, but  if not, we have to put something in its place. As a consequence, there may be some urgency associated with securing bilateral agreements to deliver that continuity. That is at the heart of what needs to be in the Bill: an ability for the existing healthcare arrangements to be replicated through bilateral agreements in short order, not necessarily waiting on the approval of the two Houses of Parliament in a logjam.
I know that Noble Lords will immediately say, “Hang on a minute, we have to be able to approve this thing”. I bring to the discussion of this Bill the benefit of having just been involved in Committee on the Trade Bill. Because there was a lack of powers, on the Trade Bill we were asked to provide the necessary powers to secure continuity and the rollover of existing agreements. In legal terms, this is not the same. We are not rolling over agreements—we may be implementing agreements—but the substantive purpose is the same: to enable healthcare provision across Europe to be provided for UK residents in the future in the same way as in the past. As we go through the legislation we need to make a distinction between what is a continuity provision and what is a new provision for new agreements. Where the Trade Bill was concerned, we did not need to do that; it was not about new agreements.
The noble Lord, Lord Marks, must be careful with the point he made about Clause 5 and regulations that,
“may amend, repeal or revoke primary legislation”.
Yes, it can be,
“(a) for the purpose of conferring functions on the Secretary of State or on any other person”,
but he added an “or” before paragraph (b). He said,
“or to give effect to a healthcare agreement”,
but it is not this; it is,
“to give effect to a healthcare agreement”.
As my noble friend Lord O’Shaughnessy said, this is all in order to implement international treaties.

Lord Foulkes of Cumnock: The noble Lord is absolutely right to distinguish between continuity legislation and totally new provisions in legislation. Does he not agree that it is bad enough to push a number of Bills and other legislation through quickly to get it through by the end of next month when it is continuity legislation—but that if it is totally new legislation, there is absolutely no justification at all?

Lord Lansley: We spent four days in Committee on the Trade Bill. I do not know how much time is planned for this Bill but it is perfectly possible for us to consider this legislation and to put in place the necessary powers for future agreements, as long as it is done with the necessary scrutiny and approval provisions. I will come on to make one or two points about that, and I am sure we will go on to debate that robustly—as my noble friend on the Front Bench said—in the days ahead.

Lord Marks of Henley-on-Thames: I accept the noble Lord’s point that I should not have said “or”. My point is that outside the context of the withdrawal agreement, which would have been fully debated, any new agreement is a new healthcare agreement, so the limitation of the lack of an “or” does not make a great deal of difference.

Lord Lansley: I will come on to precisely that point about new agreements and the extent to which we need to amend existing legislation to give effect to such agreements.
I will say a word about what we are trying to achieve here. I do not think we should underestimate that the Government have committed to the significant, continuing—effectively permanent—cost of providing healthcare across the European Union for those who have been resident in the United Kingdom. As we have heard, this is £630 million-plus per year. There is not a corresponding expenditure in this country by other countries because it is only a fraction of that for other EU citizens and residents coming to the United Kingdom. This is quite a generous provision. It is not the case that every beneficiary of this would be eligible for healthcare in the United Kingdom. For example, a pensioner who goes to live in Spain might ordinarily cease to be resident in the United Kingdom and hence to be eligible for NHS care. So this is not simply to provide NHS care to people wherever they happen to be, nor should it be interpreted as such. It is a very specific provision.
Equally, there might be people who are in exactly the same position as a pensioner going to live in Spain but who go to live in Florida. We do not, and are not proposing to, provide such healthcare there. That is not simply because the American Government do not provide a reciprocal benefit for Americans in the United Kingdom, because the legislation does not require reciprocal healthcare. It enables the Secretary of State to provide healthcare for UK residents in other countries. The reason is straightforward and rather ironic. We propose to legislate to give continuing healthcare provision across Europe as a consequence of the freedom of movement provisions, while at the same time proposing to get rid of those freedom of movement provisions.
If we were to follow through the logic of ending freedom of movement, which allows people to live and work in other European countries and pensioners to have access to the social security regulations in other countries, we would scrap all this. But that would not be popular. It would feel very unfair and, as my noble friend Lord Kakkar—if he will forgive me for calling him that—said, this matters a great deal to people. They would be extremely anxious and distressed by the removal of something that they had been accustomed to receiving in the past.
But it may not be available in the future. We cannot say that the European health insurance card will be offered to people and available for travel and work in the future as it has been in the past, although I say to the noble Lord, Lord Foulkes, that I have just looked it up. The website is there. The bit where the Department of Health tells you about the European health insurance card is still online, but it unfortunately has to tell people that, because we do not know where we will be after 29 March, they might be advised to take out travel insurance.
The point I come back to is this: we are making a provision and we should recognise that we are doing that so as not to take away something of considerable importance for many people who have come to rely on it. We do not want to create that distress. It is a  long-term commitment and I hope that people will recognise the value of that. We cannot go around extending it easily. I am not aware of any proposals for bilateral agreements with other countries to extend this healthcare benefit elsewhere. If there are any I would be very interested to hear of them.
I hope that we will be able to replicate the current structures as far as we can in the way in which this is managed in the future, but it is important that we give proper scrutiny. I will say three things. First, we must be able to have continuity delivered rapidly if necessary. Secondly, like treaties, new agreements must be subject to prior agreement within Parliament about the basis on which the Government should conclude them, rather than Parliament simply being given the opportunity to renege on them or not. Thirdly, when it comes to the amendment of legislation, we should be very clear that not only must any Henry VIII provision that amends primary legislation be subject to the affirmative procedure, but regulations that seek to amend, repeal or revoke direct EU legislation—retained EU law of a significant character—should, equally, be subject to affirmative resolution. The drafting here does not recognise the sources of law with which we have to deal and the way in which we should deal with them in the future.
Subject to all of that, I hope that we will not spread alarm. I hope that noble Lords on the Liberal Democrat Benches will at least recognise that there is a purpose to this legislation and that in our further consideration we will ensure that it is entrenched and the Bill passes with that purpose firmly in place.

Baroness Barker: My Lords, I, too, congratulate the noble Baroness, Lady Blackwood of North Oxford, on the clarity with which she introduced this legislation. On the basis of her speech, I look forward to many spirited debates with her in your Lordships’ House. I have a fair degree of sympathy with her as she has to bring forward this Bill under the constraints of her maiden speech. I thought she did that extremely well.
Before we get lost in a Bill which is bereft of detail, it is important to reflect on the purpose of the law, which is to enable citizens to understand and exercise their rights and to enable them to fulfil their obligations as citizens. It is not to provide a blank cheque or a blanket set of excuses to the Executive. This Bill is deficient in that respect. I do not believe that any citizen of this country reading the Bill would understand their rights and responsibilities under it as of April. The noble Lord, Lord Foulkes, who went first, reported the thunder of the Delegated Powers and Regulatory Reform Committee. Some noble Lords have heard me use the description of that committee given by Mark D’Arcy, which is that they are a group of people among whom the raising of an eyebrow can be considered severe criticism. A report such as the report on the Bill is the equivalent of throwing a chair through a window because it is pretty strong:
“Clause 2 has a breath-taking scope. Indeed, the scope of the regulations could hardly be wider … There is no limit to the amount of the payments … There is no limit to who can be funded world-wide … There is no limit to the types of healthcare being funded … The regulations can confer functions (that is, powers and duties, including discretions) on anyone anywhere”.
I and many Members of your Lordships’ House have many a time sat through debates in this House about the detail of primary legislation that enables citizens of this country to go abroad for healthcare and the circumstances in which that would be approved by the National Health Service. There is nothing in this Bill about that. I wonder whether the Government are not setting themselves up for a slew of court cases at some point in the future in which people who have been unable to receive treatment in this country see that it is possible to have such treatment in another part of the world, as the noble Lord, Lord Kakkar, said, and try to do so. In particular, I am thinking of things such as fertility treatment. I do not imagine that that is the intention behind the Bill, but it is certainly possible.
We seem to be moving from a situation in which over time we have worked with our European partners, who have broadly comparable health systems and systems of publicly funded health provision which exercise similar clinical standards, and are seeking to extrapolate from that agreements with countries across the world where that does not apply and where the public provision may be extremely limited or expensive, as in the case of the United States. I think we are in some difficulty. The noble Lord, Lord Lansley, was correct when he put it to the House that the Government are putting in place temporary, almost emergency, continuity arrangements for public healthcare but have given us this Bill, which is so bereft of detail that it can be much more widely interpreted. That is a problem, not just for individuals but for business.
I shall tell your Lordships about a young man whom I talked to about 18 months ago on this very subject. He was desperately worried about his future. He is a young man who would expect to go abroad during his career and to be a high earner and highly successful. The problem is that he is HIV positive, which means that it would simply not be possible for him to pursue his career in many places. He would be unable to do so in the Commonwealth because he would have to divulge his status and either he would not be admitted or he would not be allowed to live in a country legally. He cannot go to the Middle East, and he cannot go to America due to the healthcare costs. Therefore, he can see his world and his job prospects shrinking. Coming forward at such a late date with a Bill that is so lacking in detail makes life difficult for people like him.
I noticed during the discussions in another place that questions were put to the insurance industry, which was very honest. It is as much in the dark as anybody else. It was very forthright in saying that there are only two conditions that it can deal with under the changes in our arrangements with Europe: either having the EHIC or not having the EHIC. Frankly, if we do not have it, the cost of travel insurance will go up. Not only that but it will not be as easy for people with pre-existing conditions or disabilities to get insurance to travel for business or pleasure as it is for the rest of us.
I want to concentrate on one area which I do not think has been mentioned so far—the reciprocal provision between the United Kingdom and the Republic of Ireland. From what has been said, I understand that  citizens of the Republic of Ireland and the United Kingdom benefit from the common travel area arrangements. We also have arrangements that are currently underpinned by the Belfast/Good Friday agreement. I understand that it is not the Government’s intention to cease the common travel arrangement. It is very beneficial to people on both sides of the border: people can access specialist treatment in the Republic of Ireland; equally, citizens of the Republic can travel for treatment in the north.
Ministerial statements are extremely important, so, when the noble Baroness responds, I would like her to explain whether under the terms of this legislation the arrangements between the United Kingdom and the Republic of Ireland will be those in place as of 29 March and, if not, whether they are to be updated. For example, if treatments that are not currently available were to become available in the future in either the United Kingdom or the Republic of Ireland, would citizens of either country be able to take advantage of them? That is a very important point.
I think that we are in some difficulty with this Bill, and there is a particular danger for women. They might well get pregnant within whatever the timescale is, depending on what arrangements are agreed, and they might need treatment under maternity and gynaecology services. I would like to think that at the very least we might be able to give them some reassurance that they will, if only on an emergency basis, be able to seek treatment. I have absolutely no doubt that medical people the world over will abide by the oath of their profession; they will not seek to deny treatment to anyone in urgent need. However, that is not the point; the point is that we need to try to secure arrangements around which individuals and businesses can build their lives and construct their future prosperity.
I agree with my noble friend that this is not taking back control; it is a constitutional land grab. As a matter of principle, we should not let legislation as deficient as this pass through without an intense amount of scrutiny, and I hope that the Government are willing to come back with the degree of detail that should have been in the original Bill.

Lord Ribeiro: My Lords, it is indeed a pleasure to take part in this debate, and in particular to follow the noble Lords who have spoken and to welcome our new Minister to the Front Bench in her new position. I declare an interest as a member of the EU Home Affairs Sub-Committee and commend to the House its report, Brexit: Reciprocal Healthcare, published in March 2018.
Like many of your Lordships, although I use travel insurance when I am in Europe, I am always grateful to have in addition my EHIC. Some years ago, while I was on holiday with my family in France, one of my children broke a toe while going down a slide. Faced with having to pay for her surgery and then claim back the cost, I produced my form E111 with a flourish—noble Lords may remember those days. I managed to convince the hospital authorities in my pidgin French, although that was more challenging. The E111 form worked a treat and surgery was performed at no cost to me.  The current EHIC is equally reassuring, but mine runs out in May 2019, so I seek reassurance from my noble friend the Minister that I will be able to renew it during the implementation period of the withdrawal Act—if it is finally implemented.
What happens in the event of a no-deal Brexit, the drums for which are continuing to beat in some quarters? Our report confirmed that some 27 million cards, as has been mentioned, exist in the UK, from which only 250,000 claims—less than 1%—have been made so far each year. In relation to UK citizens living in Europe, approximately 190,000 UK state pensioners, as we have heard, rely on the S1 scheme. This provides ongoing access to healthcare, the costs borne by the member state with the social security system to which the individual has contributed the longest. The scheme supports the elderly and ensures that reciprocal healthcare is a portable benefit. On page 10, paragraph 16 of our report says:
“A disproportionate number of UK citizens benefit from the S1 scheme. There are only around 1.2 million UK citizens living in other EU countries compared with around three million EU citizens living in the UK. But some 190,000 of those UK citizens are pensioners, who are more likely to benefit from the S1 scheme, compared to only 5,800 EU/EEA citizens who have registered for the S1 scheme in the UK”.
That is quite a disproportionate number.
In all this, we remain net beneficiaries. I hope that noble Lords will forgive me for focusing on the no-deal scenario, but the implications are dire for this group of UK citizens and the 27 million EHIC holders whom I mentioned, many of whom, as we know, voted to leave the EU. If the EHIC is not maintained—which is a distinct possibility with no deal—short–term visitors to the EU would need travel insurance. In giving evidence to the committee, Mark Dayan of the Nuffield Trust told us that the highest cost of travel insurance was the medical cost. Without the EHIC, the cost of travel insurance is bound to rise.
There is also concern about the onward movement of UK citizens living or working in the EU in relation to free-movement rights or rights to reciprocal healthcare, which are not covered by the joint agreement or the withdrawal agreement. It has been suggested that bilateral and multilateral arrangements, as currently occur with countries outside the EU such as Australia or New Zealand, could be applied to the EU. But these arrangements largely cover emergency healthcare and not the arrangements we currently enjoy through the S2 scheme in relation to planned treatments. For example, as I mentioned in my speech on 3 July 2018, the proton beam cancer treatment available in Prague and other European cities is not currently available here, although we hope it will very soon come on stream. So what reassurances can the Minister give that future relations and arrangements will protect the current S1 and S2 arrangements, which form part of the four routes to reciprocal healthcare? Reciprocal healthcare is assured until December 2020, as we have heard—if we have an agreement. In the event of no deal, which is fast approaching, what assurances can the Minister give that the deadline of December 2020 can still be maintained to allow “alternative arrangements” to be negotiated between individual EU countries and the UK?
It is important that we provide reassurance to UK citizens, many of whom are in their twilight years and have chosen to reside in EU member states, that their health needs are protected. This should happen, deal or no deal. If we end up with no deal, analysis by the Nuffield Trust shows that British pensioners will lose healthcare cover in EU states and have to return to the UK to access care. The cost of that care in the NHS is estimated at about £1 billion—pounds, not euros, although it is about the same—which is twice as much as the UK currently spends on the care of people abroad under the S1 scheme, as spelled out earlier by the noble Lord, Lord Foulkes, when he referred to this. The resource implication of such expatriate return to the UK is the equivalent of two new NHS hospitals the size of St Mary’s Hospital, Paddington. We noted in our report a large amount of evidence expressing concern at the additional costs to the UK and the NHS of returning expats. What contingency plans do the Government have in the event of such an outcome occurring?

Lord Morgan: My Lords, I do not intend to speak for very long but I begin by thanking the House and the Front Bench for allowing me to speak at all. I am afraid that I was wrongly advised about the timing of Motions today. I particularly apologise to the Minister; I was anxious to hear her maiden speech, which obviously was very successful, and I was particularly anxious to hear someone identified with north Oxford, where I have spent some of the happiest years of my life, so I am sorry.
The Bill has been described as very wide-ranging, global in its implications and, according to a House of Lords committee, “breathtaking”, but I want to focus on one aspect nearer home and try to point out how it is possible that the implications of breaking away from one Union, the European Union, can lead to severe and perhaps irreparable damage to another union, that of the United Kingdom. The Bill reproduces issues that we have examined before; we in the Constitution Committee have certainly looked at them. On the European Union (Withdrawal) Act there was much dispute when the UK seemed reluctant, it was said, to honour the devolution settlement and seemed less than straightforward in respecting the reserved powers accruing to the Scottish Parliament and the Welsh Assembly.
It seemed to me at the time that quite needless acrimony was created by that, and indeed that it was a gift for nationalists north of the border and the movement for independence, which I do not support and do not wish to see flourish. At present we have the same kind of division and conflict over authority in relation to the Agriculture Bill, with exactly the same points being made about where authority lies. We find there is a persistent threat of conflict every time the Government try to make wider or international arrangements that will follow Brexit and engage in the repatriation of powers from the European Union. We have the same kind of argument, which to me indicates again the lack of care and preparation taken, particularly in the astonishingly few weeks that remain for the implementation of Brexit.
Strong criticisms have already been expressed in this debate about the wide delegated powers given to Ministers—the greater powers of Henry VIII and other monarchs—which are going to be adopted very rapidly. The argument over devolution is more serious still and deeply worrying, since it affects the corporate structure of these islands. As a Welsh person, I find it deeply worrying that an area where no serious argument currently exists is now being fomented.
At the moment, we have deadlock. The Scottish Government have withheld consent from the Bill on principle and claimed that it lacks clarity about their role. The Welsh Government have been a good deal more moderate, but they have also withdrawn their consent to the Bill so far. Both devolved Governments feel that in health—which is clearly a reserved area, like agriculture and fisheries—the Westminster Government are riding roughshod and with little courtesy over their agreed competencies and ignoring much of the context in which the devolution settlement has continued; the Sewel convention seems to be completely set aside at this time. It seems to them—and one can see the argument—to be an almost colonial attitude adopted by English nationalists to unbalance a complicated and careful devolution settlement that has acted in a stable way and been extended over the last 20 years.
There are two issues. One is the simple intellectual issue about authority and whether international agreements about healthcare such as this one have anything to do with devolution. Are they an external matter or, as the Scottish Government have argued, since these measures have to be implemented by the devolved Governments—in areas of competence such as agriculture, fisheries and health—are they therefore their responsibility? The situation is very unclear; it is a permanent, unresolved, intellectual conundrum that has cropped up time after time and will go on doing so, damaging not merely our external position but the internal integrity of the United Kingdom.
The other question that we on the Constitution Committee have been asking in vain for a long time is: who decides how these matters are to be resolved? Quis custodiet? At the moment, we have the Joint Ministerial Committee and I can be completely impartial in saying that over the years it has been totally useless. Even being partisan, I say that it was useless under Labour, under a coalition Government and under a Conservative Government. We raised the fact that it has not been effective in the Constitution Committee the other week with the Chancellor of the Duchy of Lancaster. He said that these difficulties arose because, latterly, we have had different Governments—nationalist, Labour and Conservative—in different parts of the United Kingdom. That is of course a complicating factor but it is not the real issue at all because the essential point has not been decided.
It has not been decided because the Joint Ministerial Committee is an ineffective body, with erratic membership and occasional hours of meeting. There are more meetings at present under Mr Lidington, which is a good thing. But otherwise, speaking as an historian, it rather reminds me of Lloyd George, who did not have proper Cabinets; he had meetings of Ministers, carefully chosen or sometimes not chosen at all but simply  those who turned up. It has been rather like that. We have this very important constitutional issue affecting the integrity of our country and decided by a body that is not at all fit for purpose, particularly in handling very sensitive areas of intergovernmental relations in the United Kingdom.
The question of intergovernmental relations has been very unsatisfactory and it is ironic that in discussing Brexit measures, which are designed to point out the centrality and integrity of the United Kingdom in standing up to its international situation, those measures may have the reverse effect. As previous speakers have said, Brexit is a totally disastrous prospect for this country. As we are already seeing, it will make it economically weaker and less confident. I fear that if we continue to have these divisive issues over devolution, the loosely associated union state that is the United Kingdom may find it difficult to be a country at all.

Lord Thurlow: My Lords, it is a pleasure to welcome the noble Baroness, Lady Blackwood of North Oxford, and I congratulate her on her fine maiden speech. She has certainly hit the ground running by going straight on to the Front Bench. I thank the Library as well for its excellent briefing for this debate.
I laud the efforts of the Government to recreate or replicate the pre-Brexit arrangements within the EEA and EU, while anticipating the future. It is of course of mutual benefit to EEA citizens as well—the noble Lord, Lord O’Shaughnessy, referred to this. But given our apparent failure to collect our share of the cost inflicted on the NHS, in my opinion those countries would be mad not to agree. Given the important comments on Henry VIII powers raised by the noble Lords, Lord Foulkes and Lord Marks, and particularly by the noble Baroness, Lady Barker, I should declare my membership of the Delegated Powers and Regulatory Reform Committee. We were not preparing furniture for throwing through the windows.
My concern is the failure to accurately calculate the cost of our great National Health services as supplied to foreign nationals. The current arrangement with the EU and the EEA allows for a reconciliation on a pro-rata basis for cost recovery—quite right, very sensible and fair. However, it is evident that we in UK cannot work out how much those users from overseas—possibly not those carrying the appropriate cards—cost the NHS. It appears that there is no universal, accurate mandatory recording system in place at the point of delivery.
In my local hospital, which is a very large NHS one, to try to set about recovering costs, people walk around with clipboards inquiring of people in the hospital who have not given the necessary data information on arrival, trying to find out where they have come from and whether or not they are entitled. It is ridiculous. You can imagine the success rate of the people with the clipboards, trying to find out information from those who are not entitled, in particular from those who know they are abusing the system. There have been attempts to improve these systems, but we see continued—extensive, probably—financial shortfall in this area, partly from Europe and particularly from those outside the European Union.
We proudly boast that our great NHS is free at the point of delivery. It certainly is; it appears to be free for the whole world. There have been attempts to overcome this unintended anomaly, but hospitals and others are reluctant debt collectors; they are, after all, in the healing business, not the banking business. We need to design a system that works without asking the health industry to collect the money. An ID system that works and is not easily abused must be capable of simple introduction—they seem to do it elsewhere very effectively.
I was going to refer to statistics. We have heard a lot about the numbers of UK residents living in Europe, the number of retirees living in warmer climes, those who use medical services in continental Europe because they have been referred, and so on. But the fact is that there are apparently some 3 million EU nationals living in the UK, and 1 million British nationals living in the EU. Yet we recover only 10% of what they recover. I do not get the arithmetic. I am sure I will be corrected—

Lord O'Shaughnessy: I can tell the noble Lord the reason for that. It is fantastic to hear somebody from the Cross Benches supporting the efforts that the Government have been making for cost recovery, because it is not always a popular topic in this House. One of the main reasons is that if you are here for six months or if you have made your home here, wherever you are from, you are counted as ordinarily resident and are therefore entitled to free care. That is a founding principle of the way the NHS is set up, and the reason for the discrepancy that the noble Lord talks about. It is not a failure to deliver costs—it is an entitlement that anybody from any country has if they are counted as ordinarily resident under the law.

Lord Thurlow: I thank the noble Lord for his clarity.
Health tourists are a different category. The BMJ reported 18 months ago that in the year before, some 50% of births at a particular London hospital were to mothers not entitled to NHS services. I realise that this is a completely different category, but health tourism is something we are all aware of. The estimates I have read of the cost of this to the NHS vary from £300 million to £500 million; a senior doctor at a London hospital estimates that the figure is well over £1 billion. There appears to be a well-organised shuttle service of sorts from west Africa, giving access to those who can afford the service, no doubt for a great price. Are our doors really that wide open to this abuse of taxpayers’ money?
Why my interest? I am not a ranting, Brexiteering, screaming far-right nationalist, I promise you. I am doing this as a taxpayer and we, the legislature, owe a duty of care to all British taxpayers and citizens. The Second Reading is the first opportunity for us to debate the key principles, the main purpose of the Bill and to flag up concerns. To read that the cost of the mix of inefficiency and fraud may cost the NHS only £300 million or £500 million is insulting. Just try getting that out of the Treasury for your next worthy project. Does the Inland Revenue stop chasing us when it gets down to the last £300 million? We are all taxpayers, all paying for this shortfall.
In 2014, the visitor and migrant NHS cost recovery programme was, I believe, implemented. It sought a target, for some reason, of £500 million per annum. To do this it wanted to improve existing charging systems, laying a health surcharge on non-EU citizens. This Bill provides an opportunity to readdress this programme and so support the principle of fairness by ensuring that those not entitled through treaties pay for their care. It requires that the particulars of NHS access entitlement must be made completely clear to foreigners as they arrive in the UK, in order to avoid confusion for both patients and service providers.
In our great liberal democracy I could easily be perceived as a bogeyman or pariah—no one else has raised these points before in this debate. Please do not do that. It is taxpayers’ money; it is hard cash. We have a duty, as I have said, to stamp out abuse. Please do not turn a blind eye to this shameful state of affairs. The UK is not a rich country at the moment. We are doing our best to recover from the great recession of 2008 to 2012. We had austerity—closing rural schools and closing or reducing hundreds of other public services. Yet we appear to waste hundreds of millions of pounds because this is in the “too difficult” category. At the least, we could let DfID pay for the illegal health tourists through the aid budget. After all, it is foreign aid.
We must create an effective system to record the origin of unentitled users of the NHS, and allow for the accurate reconciliation of costs as the system is set up to do. To stop health tourism, users must pay. It is not a job for medical practitioners, but we have hospitals staffed by highly paid administrators. If remedied, hundreds of millions of pounds could be added to the funding of the NHS. Why is cost recovery not more effective and what, if anything, is being done to radically overhaul the system which allows this shameful waste of taxpayers’ money?

Lord Bethell: My Lords, I thank the Minister for her excellent introduction and her absolutely excellent maiden speech. I have known her since before she was an MP, followed her progress with absolute awe and grown to respect particularly her expertise in health technology—an area which is a huge opportunity for the country but will also need a lot of scrutiny from the kind of expertise found in this House. I look forward to many engagements on that subject.
On this legislation, I thank the members of the Home Affairs Sub-Committee of the EU Select Committee—the noble Lord, Lord Jay of Ewelme, and his fellows—for their excellent report. What I found striking was the great concern it expressed about the potential loss of existing reciprocal healthcare rights, the dangers of the cost to the NHS and the potential administrative burden, and the large amount of coverage that the report received in the press. It was a brisk reminder of how an overlooked area of policy and machinery of government which is precious to a lot of people needed to be focused on as we approach Brexit.
I was grateful to the noble Lord, Lord Thurlow, for his reminder of the costs of this area of government—it was an important point. I was grateful also to the  noble Lord, Lord Lansley, for reminding us that, if we are to take away freedom of movement, we should perhaps get rid of such reciprocal rights—there is a sort of logic to that. I am here to reject both those arguments and to make an appeal in the opposite direction. I want to try just for a moment to extend the debate outside the Chamber, beyond Brexit and Henry VIII powers, to offer a little reminder of how many of the public might regard this as not only a healthcare issue but as one that touches on a subject that is very important to most of them; that is, travel.
Travel has changed dramatically in the public mind. It is not felt to be a luxury any more, as it was when I was a child. It is felt more to be a right and a form of expression; it is a part of one’s education, and it is critical to business. We can all wonder about the sense of entitlement among the modern generation, but I for one celebrate the benefits of travel. It satisfies the yearning to improve oneself personally and, among the business community, enables one to reach exciting new markets. In the context of this debate, we have not really talked much about the benefits of travel both to the country and to individuals. Underpinning that yearning for travel is a desire for frictionless, risk-free and affordable travel. The reciprocal rights that we are talking about are there to provide that kind of cover.
I do not think that there will be a massive change in the country’s mindset in respect of travel just because of Brexit and 29 March; if anything, quite the opposite. There has been a huge boom. Last year, Britons undertook 73 million trips overseas, representing an increase of 4% on the year before—that is a hell of a lot. That growth has gone on at a very steady rate for many years. That growth will go on into the future and we should think in policy terms about its implications. The range of destinations that people are travelling to is only getting wider.
People are also relocating in later life. We have heard a lot about the 190,000 people who have already moved to Tuscany, Provence and the costas, but that number is also edging up. We have to accept that we face the possibility of making provision for an ever larger number of people.
Some 27 million Britons already have an EHIC—the noble Lord, Lord Foulkes, showed us his; I thank him for that. We in my family have six of them; I do not have mine with me. I was staggered when I heard that the figure was 27 million. That is an unbelievable number. For a public policy to be quite so successful and to get through to nearly half the country like that is a huge achievement. There will be public policy professionals who are incredibly envious of that sort of penetration. There were 250,000 claims against those cards last year. Again, that is a daunting number—much higher than I could have imagined.
My appeal today is for us to try to think about this policy not just in terms of the daunting prospect of Brexit, the constitutional implications of the Bill and the cost, but through the lens of the macro changes that we see in society about people’s yearning to go overseas, to take their business and their families with them and to see other lands. We should think about future-proofing this overlooked part of our healthcare provision and accepting that we may need to extend  those arrangements in terms not only of their geographical reach but of the sophistication of how we manage them. We should communicate a clear statement to British people and the outside world that nothing that happens around Brexit is about turning our backs on the world or closing the doors. Rather, we should show through our reciprocal healthcare arrangements that we will guarantee fair and reasonable treatment for people who visit Britain and support our own citizens who might run into difficulties when they travel abroad.

Baroness Brinton: My Lords, I join others in welcoming the noble Baroness, Lady Blackwood of North Oxford, and congratulating her on her maiden speech. It is always slightly bizarre for a maiden speech also to be a ministerial introduction to a Bill, but she did it extremely well and set out the case. Along with my colleagues on the Liberal Democrat Benches, I may disagree with some of the things that she said, but she set out the Government’s position eloquently.
In addition to thanking the Library for its very good briefing, I want to thank the BMA for its own. One point that it makes has not been covered so far in our debate today. It says:
“It is essential that any alternative cost-recovery system introduced post-Brexit should not place an undue burden on either the NHS or on doctors or allied health professionals working within the health service”.
In view of the rearrangement of the BBC charter, whereby the BBC is taking on responsibility for the public benefit of TV licences for the over-75s, I worry that a Government in future might take the attitude that it is perfectly acceptable to offset—so I completely support the BMA in saying that it must not affect costs.
Others have spoken eloquently about the number of UK residents who hold EHICs and have received reciprocal treatment. I speak as someone who lost their father-in-law 10 years ago in France. He had the most wonderful treatment over a three and a half-week period after a brain haemorrhage, but sadly died. At no stage of the treatment, moving from a front-line hospital to a big regional hospital of excellence, was there any problem with the card or the E111 form. The only slightly bizarre thing that happened was that, after he died and all treatment was concluded, my mother-in-law received a bill for the ambulance service. It was not that she had to pay it, because if one is covered by E111/EHIC form the cost is met by the state, but every family gets a copy of the ambulance bill because it reminds them how expensive it is—and, guess what, in France there is no abuse of the ambulance paramedic system whatever.
At paragraphs 75 and 76 of the EU Committee report, Brexit: Reciprocal Healthcare, published in March last year—about one year ago—the committee sets out its concerns about making sure that negotiations should start early. It stated:
“We applaud the spirit underlying this ambition”—
of wishing to maintain reciprocal healthcare arrangements—
“but it is difficult to square it with the Government’s stated aim of ending freedom of movement of people from the EU”,
which is of course symptomatic of the principle of reciprocal healthcare. It went on to state:
“More generally, reciprocal healthcare arrangements will only be achieved by agreement between the UK and the EU. The Government has not yet set out its objectives for the future UK-EU relationship. We … urge the Government to confirm how it will seek to protect reciprocal rights to healthcare of all UK and EU citizens post-Brexit, as part of any agreement on future relations”.
It is worth noting that, 52 days away from 29 March, we are still not clear about what the UK wants from the arrangements. We seem to be going back to the negotiating table. I suspect that that explains what the noble Lord, Lord O’Shaughnessy, said about the sparsity of information. It is almost as if Ministers are saying, “Trust the Government, because we don’t quite know yet where we are”.
Some of the points made later in the EU Committee’s very good report give a signpost to where we might be. Chapter 6, on reciprocal arrangements, private healthcare and insurance, talks about contingency planning for the S1 and S2 arrangements and the EHIC. I will not dwell on those, because colleagues have mentioned them, but I remain concerned about arrangements with insurers. The chapter’s final conclusions state:
“Time is now short for the Government to provide much-needed clarity to the insurance industry to help with planning, particularly for multi-trip travel insurance policies that will include the period beyond March 2019”.
It goes on to say:
“There will be consequences not just for the insurance industry, but for tourism and individual travellers. While the industry might derive some benefit should it be required to play an expanded role in providing cover, we recommend that any move for greater reliance on private medical insurance by UK citizens travelling within the EU post-Brexit be subjected to careful scrutiny, particularly in terms of the further regulatory oversight that might be needed to ensure that patients and consumers are treated fairly”.
In November last year, my noble friend Lord Bruce of Bennachie asked the noble Lord, Lord Bates, about the arrangements and advice that would be provided to UK residents planning to book a holiday in an EU member state commencing after the end of March 2019. The noble Lord, Lord Bates, said, in summary, that he did not have details, but went on to say:
“The Government continue to strongly encourage all British nationals travelling abroad, including within the EU, to take out comprehensive travel insurance that covers their personal circumstances and meets their needs. In the unlikely event of no deal, travel insurance policies will remain valid”.—[Official Report, 1/11/18; col. 1424.]
Last week, my honourable friend Tom Brake, who is the Liberal Democrat Brexit spokesman in another place, reported that we had done some mystery shopping for travel insurance in the preceding week, in January 2019. Of the seven travel insurers spoken to, only two firms said that insurance would be paid out as normal in the event of a no-deal Brexit. Three said that they did not know what would happen if a no-deal Brexit came into force. Most worryingly, two of the companies said that holidaymakers would not be covered in this event because they had not yet got any policy on it. That is why I am really worried by the lack of detail in the Bill, which is symptomatic of the lack of detail and discussions going on with the industry itself.
I will briefly touch on Northern Ireland. The noble Lord, Lord Foulkes, has spoken about the importance of arrangements elsewhere in the union. The arrangements that pertain in Northern Ireland at the moment are absolutely not the same as elsewhere in the European Union. Joint health services allow patients to get medicine at any pharmacy, north or south of the border, irrespective of the location of the GP responsible for the prescription. Ambulances on both sides of the border are currently free to travel across it to attend emergencies. People across the island of Ireland are allowed to receive radiotherapy at a new £50 million centre for cancer patients from both sides of the border in Derry. It is important that that specialist provision is available, yet there is no pathway for managing these difficult cross-border issues in Ireland. Will these current arrangements remain in place after 29 March, in the event of a no-deal Brexit? Even in the event of a deal, will it continue if there is no final agreement? Are specific discussions going on between the Republic, Northern Ireland and the UK Government to ensure that there are no cliff edges for residents of Northern Ireland or the Republic? This is not just holidaymakers, or a handful of workers abroad. This is a full, two-way process.
Finally, I move on to the Henry VIII powers. I am grateful to my noble friends Lord Marks and Lady Barker and to the noble Lord, Lord Foulkes, for expressing their concerns in detail. I will not repeat them, but I agree with them about the enormous scope of the Bill and of the underlying arrangements it sets in place. The noble Lord, Lord O’Shaughnessy, responded to the DPRRC saying that there were “too few constraints” on power by saying that there needed to be flexibility because of future trade deals. He will know of my concerns in this area, because I raised questions with him about the protection of the NHS when he was the Minister. One of the lesser-known pillars currently protecting our NHS is the EU directive on public health procurement. It governs the way in which public bodies purchase goods, services and works and seeks to guarantee equal access and fair competition for public contracts in EU markets.
I was concerned by the noble Lord’s mention of future trade deals. We know that the United States of America wanted, through TTIP, to use trade deals to get a foot in the door of larger contracts within the UK. In the past I have said to colleagues on the Labour Benches that we have the protection of the EU directive. I now worry that that will disappear in a puff of smoke if we have a no-deal Brexit on 29 March. I am grateful to the noble Lord, Lord Livingston of Parkhead, who answered my question on this issue in November 2014 by saying:
“Commissioner de Gucht”—
from the EU—
“has been very clear: ‘Public services are always exempted ... The argument is abused in your country’”—
the UK—
“‘for political reasons’”.—[Official Report, 18/11/14; col.274.]
Can we count on the Prime Minister’s statement that all EU law will be enacted fully in the UK and that if changes are to happen they will follow later? Can I take it from that that this EU directive will be enacted  and in force on 29 March to protect the NHS from unscrupulous trade deals that we were promised would not happen?
I am particularly concerned. When I asked these questions in the past, Barack Obama was President of the United States. Under President Trump I remain even more concerned about the protection of the NHS. The Minister may say that this should not be affected, because this is about arrangements, but I worry that the scope which sits behind it might actually allow it to happen—so I look forward to hearing from the Minister.

Viscount Bridgeman: My Lords, I have the rare pleasure and privilege of congratulating the Minister on her most impressive introduction of the Bill—on only her second day in the job—and addressing the challenge of a maiden speech in such style. We await her further contributions from the Dispatch Box. I welcome her as a Member of your Lordships’ House.
The Government are to be commended on this Bill. Of course, we await the outcome of the Prime Minister’s dialogue with the European Union, but the Bill has the merit of addressing with flexibility every possible outcome of these negotiations and of the future relationship between the United Kingdom and the European Union. The health of individuals is impatient with political considerations and we can therefore be pleased that the Bill comes before Parliament at an opportune time. Whatever the outcome of negotiations with the EU, the reciprocal healthcare arrangements which currently exist within the EU, the EEA and the European Free Trade Area are an achievement of which all participating countries, and the European Union itself, can be proud. I welcome the flexibility which the Bill introduces, giving the Secretary of State the power to conclude individual agreements with other states, outside and inside the European Union, should they be needed following our exit from the EU.
The noble Lord, Lord Kakkar, who is not in his place, referred to countries on the continent which advocate treatment which would not be available under the NHS in this country. For my own benefit, will the Minister clarify whether the Bill will address that problem? The Minister mentioned the light-touch arrangements that Australia and New Zealand have with this country. I was not party to these negotiations and I just ask whether the Bill is intended to enable our agreements with those two countries to be upgraded to the standard currently available in the EU reciprocal arrangements.
I recently undertook to assist a Hungarian friend of my family, who is registered with the NHS in England and who suffers from breast cancer, to obtain consent under the S1 or S2 procedure to be treated in Budapest, which she wished for personal reasons. I certainly had to go around the block getting advice, which was well-meaning but often contradictory. I eventually located the office in Leicester which handles the S1 and S2 requests and the necessary permission was granted. I ask the Minister to take the opportunity provided by the Bill to ensure that the reciprocal arrangements admirably provided for in it are publicised simply and clearly.
To sum up, this is a timely Bill. Going by the speeches of noble Lords, we can look forward to some very lively later stages, but it was admirably introduced by my noble friend in her new role and I join other noble Lords in wishing her all success with it and all other health matters in your Lordships’ House.

Earl of Dundee: My Lords, I join others in congratulating my noble friend the Minister on her very useful introduction of this debate and on an excellent maiden speech.
I welcome the Bill but I share concerns over a number of its defects. These include: inadequate parliamentary scrutiny; insufficient awareness of cost consequences; and, still left by it, the degree of uncertainty affecting United Kingdom citizens living abroad and foreign citizens living here. As my noble friend Lord O’Shaughnessy explained, it is sensible that the Secretary of State should be given wide powers. Since any particular Brexit outcome is as yet unknown, that is the best way to protect international healthcare arrangements in a Bill such as this. Thereafter, no doubt, the negative statutory instrument procedure might otherwise have been the right method for ongoing parliamentary supervision. For, as the Government already argue, by then, although not now, the focus of Parliament would be able to be on a specific post-Brexit healthcare agreement. Also, negative statutory instrument procedures are often the means of looking at regulations made under all Bills, including this one.
The alternative is to make use of the affirmative statutory instrument procedure. In this instance, does the Minister agree that we should do that instead? There are clear benefits. These are against a background of public anxiety over all post-Brexit plans and their detailed results, corresponding to a correct and increasing public desire for maximum transparency. The affirmative procedure responds to this demand. Its deployment instead of the negative procedure—against which the noble Lords, Lord Foulkes, Lord Marks of Henley-on-Thames and Lord Kakkar, among others, have warned—would therefore provide much greater reassurance that ongoing parliamentary scrutiny will be carried out in a proper and accurate manner.
As a number of your Lordships have cautioned, we might also harbour misgivings about excessive costs. So far, these may have been underestimated because meaningful budgeting has to depend upon the terms of a future withdrawal agreement—as yet a matter for speculation, not least on whether there will be one at all. In view of that, as my noble friend Lord Ribeiro emphasised, it is impossible just now to anticipate the financial burden on the NHS of British nationals who might return to the United Kingdom for treatment; equally unable to be calculated at present are the administrative costs of carrying out, as envisaged, all sorts of concordats with the European Union, with the EEA and with other countries across the world. Clearly, we hope for efficient reciprocal healthcare arrangements arising from a competent withdrawal agreement at the outset. However, although germane and even crucial to it, these still lie outside the Bill. Within its scope, conversely, is the opportunity for Parliament to monitor all expenditure and income to  do with healthcare plans. Does the Minister therefore concur that reports with these details should be laid before Parliament annually?
On this issue in another place, the Government may have prevaricated slightly and hidden behind the skirts of obvious current circumstances. While they say that the Bill should not prescribe a particular timetable for reporting back until new healthcare plans have come to light, they also claim that a number of reporting processes can anyway be deployed instead. Yet is there not a simple and necessary corollary to this? If we really want to increase confidence and transparency, why not just make sure that Parliament is given relevant healthcare facts and figures at least once a year? Then, if the Government wish to report further through any other processes, they are free to do so.
Then there is the safeguarding of the reciprocal healthcare rights of United Kingdom citizens abroad and foreign citizens here. The aim is to avoid slippage and to maintain equivalence. This is the common theme of all post-Brexit challenges and obstacles, which many of us, including myself, while determined to meet and overcome them, are also regretful to have to confront at all, believing as we do that by far the best deal for the United Kingdom would be not to leave the European Union in the first place. Along with us, United Kingdom citizens living abroad will acknowledge the usefulness of the Bill. Nevertheless, at the same time, and as we do, they will recognise that for the proposed legislation to work efficiently, a robust and reciprocal deal for international arrangements has to be put together to begin with.
Meanwhile, the Bill should be improved in several respects, amended so that parliamentary affirmative procedures and annual reports can enhance supervision and transparency, and, as your Lordships have urged, with a stronger commitment of intentions to the people concerned, through a proper undertaking to those wishing to travel and who suffer long-term medical conditions. There must be a firm resolve not to short-change but to preserve reciprocal medical delivery as it is, and there must be greater clarity on the role of the European court to protect such standards as they are.

Baroness Jolly: My Lords, I join other noble Lords in welcoming the noble Baroness, Lady Blackwood of North Oxford, to the Dispatch Box and in congratulating her on her very fine maiden speech. I hope she learns to love her brief. On these Benches we look forward to working with her, improving legislation and asking fairly regular questions.
One of the privileges of membership of the European Union is that, no matter where we are in the EU, our health needs are safeguarded when we need medical attention. Under EU agreements, the UK has participated in a variety of reciprocal healthcare arrangements with other countries, with the result that all citizens and visitors are protected. This Bill aims to allow the Government to implement new relationships with our EU neighbours, but it goes far further. It aims to give the Secretary of State powers to fund healthcare outside the UK and to give effect to healthcare arrangements  between the UK and other countries. It gives data powers to the Secretary of State that exceed what one might think he or she should need.
We know how crucial it is that people’s health is protected after 29 March. In 2016, 91,000 British citizens used their EHICs while abroad in Spain. In Germany, 22,000 British citizens accessed medical help when they urgently needed it. Each year, thousands of older British people who have retired to the EU rely on reciprocal healthcare to access services as they age. Kidney Care UK has called for greater certainty for people living or travelling abroad with long-term health conditions and for those of us who have booked holidays for after Brexit. The BMA warns that care needs may not be met if many people are forced to return from abroad where their health needs are no longer covered. The BMA and the Nuffield Trust have estimated that in that scenario, an additional 900 beds might be needed. Of course, social care might also be affected.
A Bill of this kind is necessary if we are to leave the European Union. I do not believe that the extraordinary scope of the overall Bill has been adequately justified by the department, and I have several areas of concern. First, I am concerned by the extent of the powers called for. This issue has been raised several times today, but it is important to reiterate it. In November, the House’s Delegated Powers and Regulatory Reform Committee described the scope of Clause 2 as “breath-taking”. The committee noted that the clause covers everything from what kinds of healthcare can be funded to whom functions can be delegated to. That would appear to be everyone, everywhere. The Bill does not limit its scope just to Europe. It calls for worldwide powers to make healthcare agreements with any country, anywhere. Why is this necessary? Surely the focus of the Bill should be purely on building new agreements with the EU and EFTA countries.
Clause 4 makes any healthcare provider and anyone the Secretary of State decides an authorised person. Does this mean that confidential health records can be shared with private healthcare providers and anyone else the Secretary of State gives authority to, in the UK or abroad? I appreciate that data is important, but I wonder whether the Government are getting distracted from the key issue at hand.
In direct contradiction to the Government’s promises regarding the Bill, only last week a no-deal technical notice was published by the Department of Health and Social Care which recommended that British nationals living abroad should buy health insurance.
I am seriously concerned by the lack of comprehensive affirmative procedure in the Bill. Under this version of the Bill, regulations which do not contain provisions that make modifications to primary legislation are subject to the negative resolution procedure. Simply put, the Bill does not make provision for adequate parliamentary oversight, is too wide, and is unfocused in what it covers. As the DPRR Committee noted in paragraph 11 of its report, there is nothing that would prevent the theoretical funding of incongruous or excessive health procedures with the blessing of the Secretary of State. It is regrettable that these issues have been raised countless times since November, yet  the Government have not fully explained why they request so much power and so much scope. Will the Minister, in her summing up, therefore justify in plain terms the reasons for the Bill being formulated in such a way?
I will spend some of my time considering the issue of devolution. I was glad to catch up with the noble Baroness at a recent meeting before she became Minister, when we were able to share ways of working—probably the nicest way to put it—which could be useful. I was pleased to hear that the Bill team has been working closely with Scotland, Wales and Northern Ireland, as the Bill will affect their NHS systems too. Scotland and Wales have already voiced their support for the Bill, but I will draw attention to some reservations. The Senedd noted that,
“given the significant impact on devolved areas it is crucial that Welsh interests are appropriately considered in the development of reciprocal health arrangements and that mechanisms are in place to ensure that the Welsh Government contributes to the making of decisions that affect Wales”.
If the Bill passes, will the Government commit to consulting the devolved nations when new reciprocal healthcare relationships are negotiated?
Northern Ireland, as has already been stated, faces a particularly tricky set of issues with regards to healthcare post-Brexit. For example, children regularly travel from Northern Ireland for cardiac surgery in Dublin, and there is a radiology unit in Derry that is a cross-border initiative available equally to patients on either side of the border. It is co-staffed and co-funded, and ambulance routes cross the border many times a day. While we are on Northern Ireland, could the Minister consider this scenario of a citizen of the Republic of Ireland living in France and returning to live in London? How do they stand with regard to the Bill? I am pleased that the Minister has confirmed that close work is going on between Westminster and relevant officials in Northern Ireland and the Republic to ensure that no individual reliant on cross-border services faces disruption in the case of a no-deal situation.
I am also concerned by the provisions for data sharing in the Bill. The noble Lord, Lord Kakkar, referred to that issue in his speech, and we will come to it in quite a lot of detail in Committee. Clause 4 provides a legal basis for “authorised people” to process personal data for reciprocal healthcare after the UK leaves the EU. This could be as part of an agreement with the EU, an agreement with a non-EU country, or in connection with no-deal plans. Clause 4 clarifies that this data sharing must be in accordance with data protection legislation. But how do we guarantee our data safety once it is exchanged with bilateral partners? Health data, by its detailed nature, proves particularly sensitive in this regard even when it is made anonymous.
In the NHS, the Caldicott principles were developed in 1997 to consider how patient information is handled across the system. Principle 4 states that access to personal confidential data should be on a strict need-to-know basis. Clause 4 does not adequately safeguard this need-to-know principle. The purpose of this clause appears to be so that we can know how many citizens of other countries are using the NHS, and vice versa. The noble Lord, Lord Thurlow, made the point earlier that it is important that we should know that, but it is  not contained in this part of the legislation. In practice, we all know that this is very tricky data to collect. NHS England and the devolved NHSs all use different data management systems. This NHS England data will be in the purview of the Minister; I wish her the best of luck with it, because it needs a strong hand.
A core value of our NHS is that it is free at the point of need. We know already that our hospitals and surgeries are not set up to process treatment charges, let alone to feed this information back into a complex system to be adequately anonymised and passed to the relevant country. We heard about dummy bills; I lived in the Middle East for some years in the 1990s, and in the country where I was living healthcare was free. You went to see the doctor and were given a prescription, you had a conversation and might be referred on, and you were given a dummy bill so that you understood what the value of your care was. That was quite an eye-opener. I am sure that it would be quite difficult to implement here—they were starting with an almost brand-new health service—but it brought you up short and made you think. Have the Government fully considered the practicalities of implementing some aspects of Clause 4?
I fail to understand why the Bill is of global scope when it is brought in in order to mitigate the damaging effects of Brexit. The Bill should refer to future reciprocal health arrangements with EU and EFTA members only. I am also worried by the extent to which data protection and devolution issues have been considered. These are key areas where the Government can achieve their objectives to guarantee reciprocal healthcare without reaching for such powers. It seems that the Bill embraces a somewhat laissez-faire approach to our future international healthcare arrangements. By asking for far-reaching powers, the Government neglect thinking critically about what they will truly need to negotiate future agreements.
I am sure that we will explore these issues in more depth in Committee, when I hope that the Minister will listen to and act upon the concerns that are expressed by this House. Parliament should not, and I am sure will not, lightly hand such sweeping powers to the Executive to do as they please. Parliament has the right to say no. If the Government do not listen to this House and do not act to limit the powers in the Bill, we will have no choice but to vote against its passing at Third Reading.

Baroness Thornton: My Lords, I welcome the Minister to the House and congratulate her on an excellent maiden speech. It combined the essential description of the Bill before the House with revealing the formidable talent and understanding that she will bring to her new life. I do not recommend that she leave herself so short of time to be in her place, and I apologise to the House—I was just at the door and only just made it into my seat. It is not my normal practice.
The debate has reflected the importance, if not the size, of the Bill, as was remarked on by my noble friends Lord Foulkes and Lord Morgan. It would seem that the Bill is regarded, as the Minister in the Commons said in the helpful briefing we had, as the most straightforward and simple piece of healthcare  Brexit legislation. By now, I gulp at what the rest of the legislation will look like if that is the case. Although it has only six clauses, it has potentially profound effects and implications. Our job is to test those and make amendments accordingly if necessary. We must not allow the shortness of time—entirely, I must say of the Government’s own making—to deter us from our job, particularly as concerns the powers that the Government intend to take in the Bill. Of course, the Government always have the option to extend Article 50 if they find themselves in a pickle and not ready on Brexit day.
As most noble Lords have said, and of course we agree, it is blindingly obvious that the Bill is essential. As I said in my speech in the debate on the European Union Committee report on reciprocal healthcare on 3 July—a debate led by the noble Lord, Lord Patel—healthcare for people working, living and travelling across Europe and those coming to the UK is clearly an urgent matter to be resolved. Here we are, within weeks of leaving the European Union, whether by accident or by deal, and this issue is still not yet resolved. Worse, as the BMA states in its briefing note:
“Brexit could lead to obvious and significant changes in these existing reciprocal healthcare arrangements. The BMA has repeatedly warned that a ‘no deal’ Brexit could lead to reciprocal healthcare arrangements for UK citizens and residents within the EU, and EU citizens and residents within the UK, ending. This would lead to significant disruption to those individuals’ healthcare arrangements, an increase in insurance costs, and uncertainty regarding access to healthcare abroad”.
This affects millions of people. The contribution of the noble Lord, Lord Bethell, was interesting, because it recognised that 27 million people is a large part of our population. I cannot imagine many other things where half the population have signed up to something.
Many of our fellow citizens in Spain are watching the progress of the Bill with some anxiety. The Government have said that they want both UK and EU citizens to be able to continue to use the EHIC scheme after Brexit, but that this would need to be agreed as a part of any deal on our future relationship. The future relationship will be negotiated in the transition period—which of course, as we know, is not the same as the withdrawal agreement as we know it. However, in the absence of an agreement on future relations, the right to reciprocal healthcare enjoyed by our 27 million UK citizens through the EHIC will cease after Brexit. When at our very helpful briefing I asked the Commons Minister his advice in those circumstances, he advised us to take out health insurance. That is now on the website. The Association of British Insurers, which gave evidence to the Commons in Committee, said that the estimate of costs varied between 5% and 20% in the increase on travel insurance, but that there is a difference between travel insurance and health- care insurance and there is the matter of pre-existing conditions, which the Financial Conduct Authority has been examining, as the noble Baroness, Lady Barker, pointed out.
I always try to look at practical examples of what might happen under such circumstances. I am thinking about my late mother, living with COPD as she did for the last 10 years of her life, and taking her on holiday  to France. This is what happened. Of course, we had the EHIC in place. An agreement with oxygen suppliers in France resulted in a discussion with our oxygen suppliers in the UK and, when we arrived in the place where we were staying in France, there were the oxygen supplies and equipment and a wheelchair if needed—free because of the reciprocal agreement. Perhaps the Minister will write to inform me what I might need to do under the circumstances and what might be the cost to my family today.
I hope that the Minister will have had the chance to read the letter sent to her right honourable friend the Prime Minister last week from the coalition of the British in Europe concerning the potential plight of UK pensioners living in the EU facing no deal. What is her advice to the 190,000 mostly older Brits who face the end of the S1 scheme under which the UK pays for their healthcare, which will come to an end under no deal? That was confirmed by the European Union last week. The announcement on the Government’s website last week is causing panic and alarm among UK citizens who are dependent on the scheme for life-sustaining treatment and medication. That was echoed wonderfully by the noble Baroness, Lady Jolly.
We have a Bill that is small but broad in its intent and goes wider than addressing the issue of reciprocal healthcare in the European Union. Despite the siren calls of the noble Lord, Lord O’Shaughnessy, and the Minister, it seems to open the door to healthcare negotiation across the rest of the world. In other words, it also lays the basis for trade and foreign affairs discussion concerning healthcare. One must ask: which countries do the Government have in mind, and for what purpose and why is the Bill addressing world issues and not limited to the European Union? On these Benches, we are very concerned about the scope and believe that the Bill does not need to address the whole world at this point, when I think we have enough on our plates just sorting out the 27 million EHIC holders in the UK and their interests.
I suspect that either a Minister or one of their very bright civil servants decided that this was an opportunity to start a discussion about healthcare deals in many other countries by making the Bill an international healthcare Bill. Frankly, where I come from, we call that being too smart by half. We on these Benches are not at all sure that this is good idea. If one thinks of the international aspect of the Bill combined with the regulatory power that it gives the Government, there is justifiable cause for alarm. It is reasonable for us to probe the suspicions raised by the noble Baroness, Lady Brinton, about the USA’s eyes on our National Health Service. To deny that that exists is simply not true: of course it exists. Are we putting a Bill on the statute book which will allow that to happen? That is what we are asking.
The Government will have to go some distance to convince noble Lords that this can be justified and explain to us why we do not have before us a much simpler Bill that is smaller in scope, addresses the very important EU issues post Brexit and gives the Government appropriate powers to deal with them. The Commons Minister said:
“The Bill will support the potential strengthening of existing reciprocal healthcare agreements with countries abroad and around the world, and will potentially add to their number as part of future health and trade policy”.—[Official Report, Commons, Healthcare (International Arrangements) Bill Committee, 29/11/18; col. 24.]
I think he rather gave the game away with that. As noble Lords have said, powers in Bills are for ever, not just for Brexit. That is my interpretation of the guidance used by the legislative Committee. The question of international scope is so important because of the powers conferred on the Secretary of State by the Bill. It is not often that one reads that:
“Clause 2 has a breath-taking scope. Indeed, the scope of the regulations could hardly be wider”,
in a Delegated Powers and Regulatory Reform Committee report. The report goes on to list nine areas in which the Bill confers unlimited powers on the Government. Noble Lords have mentioned some examples, so I will do so too. The fifth point in paragraph 10 states:
“The regulations can delegate functions to anyone anywhere”.
The noble Lord, Lord O’Shaughnessy, can say that the Government’s intentions are fine, but that is not the point. The point concerns the powers given to Ministers and Governments, which we must look at.
Noble Lords more knowledgeable than me have spoken at length about the report. How does the Minister intend to respond to it? When will we see the Government’s response? I hope that it will be before the next stage. So far, the Government have failed to convince the DPRRC, our colleagues in the Commons or my noble friend Lord Morgan and other noble Lords who raised these issues that these powers are necessary. The Minister can anticipate engaging with the House about these regulatory powers; as she will soon learn soon, this is standard fare to noble Lords and an important aspect of our revising role.
I want to ask the Minister about the interesting challenge created by the regulations subject to the negative procedure. She will be aware that they have a 40-day time limit. When does she intend to put them down? To deal with them before exit day, that suggests 18 February, but I may be wrong. What is her intention for them, because that date will come before we have finished considering the Bill? We need to question the powers in the Bill, but there are other matters to consider. As the noble Lord, Lord Kakkar, and other noble Lords explained, Clause 4 is loosely worded about the necessary use of patient data; I suspect that the House will want to address that. I have been in touch with the NHS National Data Guardian. Has the Minister also sought her guidance on this matter?
There are very serious issues around the arrangements between Northern Ireland and the Republic of Ireland, as mentioned by the noble Baroness, Lady Barker, and other noble Lords. Finally, the issues of cost, review and accountability are missing completely from the Bill as it stands, as mentioned by the noble Earl, Lord Dundee. It is important to reiterate that we on these Benches agree that reciprocal arrangements are vital. They should be straightforward but the Bill’s complexity and scope puts them at risk. The Minister will need to listen carefully to what the House has to say and make good her promises to do so at an early stage.

Baroness Blackwood of North Oxford: My Lords, I thank the House for a most robust and incisive debate. It is great for me to be welcomed into a very balanced House, with the noble Lord, Lord Marks, admitting that he campaigned against me and my noble friend Lord Lansley having campaigned for me. I feel as though I have been welcomed into a warm embrace. The debate has been strong and, as anticipated, a great lesson for a former Member of the other place. I will attempt to answer as many questions as I can and address the major issues raised. If I cannot, I will write to noble Lords.
First, I am grateful for the widespread support for the intent of the Bill, which, as the noble Baroness, Lady Thornton, said, is essential. As the noble Lord, Lord Bethell, reminded us, it has strong public support. There is a desire to maintain robust reciprocal healthcare arrangements, which benefit many people across the country when working, living, studying and travelling abroad. Every day, the lives of people across the country are improved by these arrangements. Examples range from a young British student with severe asthma, able to study for a year abroad at a European university, to a British grandmother with multi-morbidities, able to visit her newly born grandchild—or, in my case, a young bride with a rare disease honeymooning in perhaps one of the most romantic cities in the world: Venice. On the value of this scheme, it is notable that many noble Lords have their own stories to tell about the importance of us maintaining reciprocal healthcare. I will write to the noble Baroness, Lady Thornton, about her mother’s case when I have found out the details for her.
All these journeys are made easier by a reciprocal healthcare system ensuring that if you require healthcare in another EU member state, you will be looked after. The British Government want such arrangements to continue; the Bill provides a legislative framework for that. I recognise that a number of noble Lords have raised important and substantive issues concerning the Bill. I will address as many of them as possible in the time available but I look forward to debating them further in the coming weeks.
The noble Lords, Lord Foulkes, Lord Marks and Lord Thurlow, the noble Baronesses, Lady Barker, Lady Brinton and Lady Jolly, and my noble friend Lord Dundee mentioned the DPRRC report. It was characteristically robust, as I said in my opening remarks. The Government responded to it; I placed a copy of that letter in the Library for your Lordships’ consideration. The committee will consider that response on 13 February, which I will take into account and reflect on very carefully. On the Bill’s powers, we must find a balance between the flexibility and agility we need as we go forward into our EU exit and appropriate scrutiny, as my noble friend Lord Bridgeman said so eloquently.
It may be helpful for me to outline the five delegated powers in the Bill in a little more detail. Four of those powers come under Clause 2, and one under Clause 4. The first, in Clause 2(1)(a), would be used to set out in detail complex payment arrangements under reciprocal healthcare deals. The second, in Clause 2(1)(b), is needed to provide healthcare abroad outside reciprocal  healthcare arrangements. The third, in Clause 2(1)(c), is needed to give effect to comprehensive healthcare agreements entered into in another country or international organisation, such as the EU. The fourth, in Clause 2(3), is needed to allow the Secretary of State to give directions to a person to whom they have delegated functions under the Bill. The fifth, in Clause 4(6)(e), enables the Secretary of State to make regulations to add to the list of people who can process data for the purposes of the Bill, for example a future arm’s-length body that does not currently exist. I know that data issues have been raised by a number of your Lordships, which I will return to later.
I know of a lot of legitimate concern over the inclusion of Henry VIII powers in EU exit legislation. The only Henry VIII power in the Bill comes under Clause 5. It is not a standalone power: it is a tidying power to ensure that the statute book is coherent when implementing future arrangements under the Bill. In particular, I have heard noble Lords’ preference for wider use of the “made affirmative” procedure, which I will reflect on more as we head towards Committee.
The noble Lords, Lord Marks and Lord Foulkes, and my noble friend Lord Dundee asked about financial reporting procedures in future reciprocal healthcare. In the letter to the DPRRC, we committed to issuing an annual ministerial Statement on the operation of reciprocal healthcare arrangements, which will be published as soon as is practicable after the end of each financial year to allow for accurate financial reporting. The Statement would include, but not be limited to: information on the expenditure and income of healthcare provisions overseas as a whole, which would include aggregated expenditure, income from the financial year and a country-by-country summary of expenditure and income; an update on the operation of arrangements, which could identify areas of successful operation or where arrangements are being improved to promote efficiency; and the strategic direction of reciprocal healthcare arrangements, which could be a statement either on future priorities for the current operation or of where the UK is engaging with other countries to establish new arrangements. I hope that that is helpful.
The noble Lord, Lord Foulkes, was absolutely right to identify the importance of EU workers to the NHS. I want to put on record again both my and the Government’s appreciation of the work of EU staff in the NHS. Let me be very clear: we want those staff to stay. I am very pleased to report that more than 4,300 more EU workers are now working in the NHS than before the referendum. We wish to continue with that positive trend.
My noble friend Lord O’Shaughnessy has already clarified the point regarding right of access to NHS services for those ordinarily resident in the UK, but the noble Lord, Lord Thurlow, and the noble Baronesses, Lady Brinton and Lady Jolly, raised the issues of the impact of these changes on the NHS and charging. Let me be clear that we do not need to have any new front-line NHS services to charge visitors or tourists from the EU, either directly or via reciprocal healthcare arrangements. We already have these processes in place as part of our current EU reciprocal healthcare  arrangements. EHIC claims and EU visitors are identified for the purposes of whether they are chargeable or directly covered through the current system. This is done by overseas visitor managers in the NHS trusts, who manage charging. The Government have been the first to make significant progress regarding charging overseas visitors and recouping funds. To reassure the noble Lord, Lord Thurlow, since 2015 we have increased identified income for the NHS with reciprocal arrangements by 40%. Directly charged income has increased by 86% over the same period. We are not satisfied with that progress, but it is certainly moving in the right direction.
I also reassure the noble Baroness, Lady Brinton, that we have work ongoing with NHS Improvement, which is now working with 50 NHS trusts, to improve further its practices in this regard, with a bespoke improvement team in place providing on-the-ground support and challenge, and identifying and sharing best practice. That should be of great assistance as we move into this next period.
A number of noble Lords raised the global scope of the powers, in particular the noble Lord, Lord Bethell, and the noble Baronesses, Lady Jolly and Lady Thornton. As I have noted, the Government’s immediate priority with the Bill is our reciprocal healthcare arrangements with the EU. That is absolutely right, but we already have a number of existing reciprocal healthcare arrangements with countries outside the EU, such as Australia and New Zealand, as my noble friend Lord Bridgeman noted. The passage of the Bill through Parliament presents us with a natural opportunity to consider how we can best support Britons in an increasingly global world. International travel is under- taken by increasing numbers of people for professional, social, recreational and humanitarian purposes. More people travel greater distances and at greater speed than ever before. Global reciprocal healthcare agreements have the potential to protect public health by supporting international visitors to access emergency and needs-arising treatment when they need it.
In addition, international collaboration through reciprocal healthcare agreements can also make it much easier for people to receive treatment, including specialised treatments, such as those mentioned by the noble Baroness, Lady Thornton, which may be more clinically effective or better for a person to access abroad. For example, as I mentioned in my opening speech, in 2017, 1,352 UK patients received pre-planned treatments in the EU, while 1,241 EU patients received pre-planned treatment in the UK. Some of those treatments would not have been possible if we did not have that scheme in place. We do not want to prevent ourselves being able to strengthen our agreements with non-EU countries by curtailing the Bill’s scope, but we must obviously ensure that appropriate scrutiny and parliamentary oversight is in place as we do that.
I move on to the questions raised by the noble Lord, Lord Marks, and the noble Baronesses, Lady Brinton, Lady Thornton and Lady Jolly, regarding trade. The Government are completely committed to the guiding principles of the NHS—that it is universal and free at the point of need. Our position is definitive: the NHS is not and never will be for sale. The Bill’s  powers are to allow the department to enter into reciprocal healthcare agreements, either bilaterally or with international organisations, entirely independently of any other international organisations or agreement. I hope that that statement is clear enough.
To reassure noble Lords even further, I will briefly set out the scrutiny powers available to the House for the international treaties under which these agreements would be agreed. It is obviously the Executive’s responsibility to negotiate these treaties under the royal prerogative. The Bill does not replace or limit the prerogative power to enter into international agreements, in the healthcare sphere or more generally. We already have international healthcare agreements, as I have stated, with non-EU countries such as Australia and New Zealand, and Crown dependencies, allowing them certain free access to NHS services.
Parliamentary scrutiny of international treaties is of great importance. Ministers are accountable to Parliament for the exercise of those functions. The principal statutory framework providing scrutiny of these treaties is the Constitutional Reform and Governance Act 2010—CRaG—established by Parliament under its own powers. CRaG has enshrined in statute the long-standing convention known as the Ponsonby rule that was the product of lengthy consultation and dialogue. The Act enables either House to object to the ratification of a treaty and the House of Commons can block ratification of a treaty indefinitely.
I understand that the House of Lords Constitution Committee has an ongoing inquiry into future scrutiny of international treaties. The Committee will look into all aspects of treaty scrutiny, which is obviously apposite at this moment, including what, if any, new committees need to be set up to deliver scrutiny of treaties post exit. I obviously look forward to the review’s findings, but noble Lords can be reassured that this Bill’s purpose is the implementation of international treaties that can be scrutinised under the CRaG process. Noble Lords can also be reassured that all international healthcare agreements will be subject to the scrutiny route considered most appropriate by Parliament.

Lord Lansley: At the commencement of the Committee stage of the Trade Bill the House voted for a Motion whose effect was that the Government should bring forward their proposals for the future scrutiny of further treaties before the Report stage. The expectation from the debate on the Trade Bill was that we would go beyond the CRaG legislation. It would be helpful for my noble friend to make it clear that Ministers will be doing that for the Trade Bill and that that bears directly on this Bill. It would be very useful for the Bill to proceed in the light of that same response from Ministers.

Baroness Blackwood of North Oxford: I thank my noble friend Lord Lansley for that intervention. One of the reasons why I raise that process is because I am aware that there are ongoing discussions in other parts of the House. We will reflect on that as we progress the Bill.
My noble friend Lord O’Shaughnessy spoke of positive engagement with his EU counterparts on bilateral arrangements in the event of no deal. A number  of noble Lords raised what would happen should the withdrawal agreement not go forward. My noble friends Lord Ribeiro and Lord Lansley both raised the question of no deal. My noble friend Lord Lansley is right that we should be careful and seek to reassure those who currently rely on reciprocal healthcare that they will be able to rely on these arrangements going forward. Great interest has been expressed by our counterparts in the European Union, where we are seeking bilateral arrangements with relevant member states in the event that we reach 29 March without a deal with the EU.

Lord Foulkes of Cumnock: The Minister has been really helpful in her reply and has dealt extremely well with the points raised. She has come to a crucial one now. I think that everyone understands that if there is a deal along the lines that have been agreed, reciprocal arrangements will continue. That is one of the positive things about it. However, if there is no deal the Minister and the Government need to be honest with us and the public about it. It will not be easy to negotiate bilateral deals with 27 different countries if we come out with no deal. If the Minister and the Government are honest about that, it will make people understand that it is vital, if we are to leave the European Union, that there must be some kind of deal, because no deal would be a real disaster for healthcare.

Baroness Blackwood of North Oxford: The noble Lord, Lord Foulkes, raises a very important point, and he is absolutely right that the Government do not seek to have no deal. The best way to avoid no deal is to have a deal. Under the withdrawal agreement there is protection of reciprocal healthcare arrangements for EU citizens in the UK and for UK citizens abroad, and that is what the Government seek to deliver. We have set out a number of steps to ensure that individuals who currently receive reciprocal healthcare can be protected as much as possible under a no-deal scenario. One of them is to put in place the powers in this Bill so that we can go very quickly to seeking bilateral arrangements. That is why I hope we will receive the support of the noble Lord as we go forward with this legislation.

Lord Marks of Henley-on-Thames: I think the point made by the noble Lord, Lord Foulkes, was that it is very dangerous to give the reassurance that the Minister was giving and to tell the public that all will be well in the event of no deal. The public need to know that all will not be well in the event of no deal. Even if this Bill and the regulations go through as quickly as they can, there will be a very serious hiatus. It is important that, rather than reassuring the public, the Government—which want a deal, as I know the Minister does—should say how dangerous it will be to leave without a deal on 29 March.

Baroness Blackwood of North Oxford: The noble Lord, Lord Marks, has made an important point. The Government have not in any way avoided the consequences of no deal. They have been very clear in outlining some of the risks associated with no deal and exactly why they are seeking a deal, with strength and authority. Those currently using reciprocal healthcare  arrangements abroad can find advice on the GOV.UK and nhs.uk websites. Any of your Lordships who would like more specific advice are very welcome to write to me or to seek a meeting with me on that.
I would like to make a little more progress, as there are only two more minutes before I must close and I have not dealt with a number of issues your Lordships raised with me. On Ireland, which was raised by a number of important Members—the noble Baronesses, Lady Barker, Lady Brinton and Lady Jolly—I reassure noble Lords that the UK is firmly committed to maintaining the common travel area and to protecting the rights enjoyed by UK and Irish nationals in each other’s states, whatever the terms of the UK’s withdrawal from the EU. The common travel area facilitates the principle of free movement for British and Irish citizens between the UK and Ireland and the reciprocal enjoyment of rights and entitlements to public services of citizens in each other’s states.
In addition, on negotiations with the devolved Administrations, we are very pleased to have received a legislative consent Motion from Scotland and are continuing to negotiate.
To conclude, I hope that I have been able to summarise the main issues and topics. There are clearly still some important questions that need to be answered, and I will write on the further points. It is clear from this debate that there is much work still to be done on the Bill, and I am sure that we will have adequate time in what my noble friend Lord Bridgeman predicts—I suspect rightly—will be a lively Committee to make sure that the Bill is in the best possible shape. However varied our views may be on the future relationship with Europe, I think that we can all agree that access to healthcare is essential both for British nationals living in European countries and for EU citizens living in the UK. We have heard that reciprocal healthcare arrangements enjoy broad public support. This Bill is designed to ensure that we can give British nationals living in European countries and EU citizens living in the UK certainty and continuity of care. With that in mind, I beg to move that this Bill be committed to a Committee of the whole House.
Bill read a second time and committed to a Committee of the whole House.

Windrush Scheme
 - Statement

Baroness Williams of Trafford: My Lords, with the leave of the House, I shall now repeat the Answer to an Urgent Question asked in another place:
“Mr Speaker, righting the wrongs done to the Windrush generation has been at the forefront of my priorities as Home Secretary. That is why I have apologised on behalf of this Government and our predecessors. History shows that members of the Windrush generation—who have done so much to enrich our country—were wrongly caught up in measures designed to tackle illegal migration long before 2010. We all bear some responsibility for this.
This Government are acting to right this wrong. Our Windrush task force is helping those who have been affected. We are making it easy for them to stay and have waived all fees—2,450 individuals had been given documentation confirming their status by the end of last year. They were all helped by the task force, which we set up in April. At least 3,400 have been granted citizenship under the Windrush scheme we opened on 30 May 2018. The task force’s vulnerable persons team has provided support to 614 individuals, with 52 cases ongoing. It continues to receive approximately 20 new referrals each week. The task force has made 215 referrals to DWP to help people restore or receive benefits; 177 individuals have been given advice and support on issues relating to housing; and 164 individuals have been identified by the historical cases review unit, of whom 18 have been identified as people who we consider have suffered detriment due to their right to be in the UK not being recognised. Sadly, three of them are now deceased. I have written to the remaining 15 to apologise.
As part of putting right what has gone wrong, we are putting in place a compensation scheme to address the losses suffered by those affected. We have consulted on this to ensure that we get it right. We will bring forward more detail on the final shape of the compensation scheme as soon as possible, having carefully considered the views that have been submitted. In December the Home Office also published a policy for providing support in urgent and exceptional circumstances. This set out the approach and decision-making process for such cases. The policy will support those who have an urgent and exceptional need, and compelling reasons why this cannot wait for the full compensation scheme.
As I said on the day I became Home Secretary, I am determined to right the wrongs suffered by members of the Windrush generation. Let there be no doubt: my commitment to this remains resolute”.

Lord Kennedy of Southwark: My Lords, reading the coverage of the Willow Sims case highlighted for me why people are worried about the ability of the Home Office to deal with these matters correctly. Can the Minister tell the House which Minister at the Home Office is responsible for the oversight of Windrush matters? How does that oversight take place? Is it a regular meeting with officials, the receipt of written reports or both—or some other mechanism? How is it that they have failed so badly in this case to exercise their duties properly and to avoid cases such as Willow Sims being treated so badly, as we have heard today?

Baroness Williams of Trafford: My Lords, we do not usually talk about individual cases but, of course, this case was brought up earlier in another place with my right honourable friend the Home Secretary. He said earlier that the letter was received only at the end of last week. It is now Tuesday. He has said that he will deal with it as a priority.
I think that the Windrush issue shames all Governments of the last 40 years or so. The Home Secretary has endeavoured in every way to make right the wrongs, as he said, and the failures of successive Governments.  Not only are the Windrush task force and Windrush scheme in place, the exceptional circumstances scheme and the compensation scheme—the details of which will be released very shortly—are also in place. We cannot rewrite history, but we can make right the wrongs suffered by these people over generations.

Baroness Hamwee: My Lords, in reporting on the Windrush generation, the Joint Committee on Human Rights, of which I am a member, said:
“We note that the new Home Secretary”—
as he then was—
“has instructed officials to take a sympathetic and proactive approach. A more humane approach to dealing with people who come into contact with the immigration enforcement system is indeed needed”.
We commented on the need for “quality assurance” and were told that a process for that was in place, although we have not heard details.
Willow Sims, who was mentioned by the noble Lord, appears to have run into trouble when a DBS check was made as long ago as last April. The Statement mentions referrals to the DWP. This is a matter for the whole of government. Quality assurance should apply to all departments that are involved. Are the other departments, including the DWP, exercising common sense and quality assurance and making referrals to the Home Office to sort out problems, which, as a matter of common sense, one would like to see?

Baroness Williams of Trafford: Certainly, there has to be a co-ordinated approach to this whole Windrush issue, as the noble Baroness said, and quality assurance is absolutely paramount given what some of these people have suffered, some for many years. So she is absolutely right. The DWP is certainly one of the referral routes for the Windrush generation because some of them may have lost or not been able to receive benefits to which they are entitled. I totally take her point. Yes, my right honourable friend did say when he became Home Secretary that a humane approach was definitely the new culture within the Home Office.

Viscount Waverley: My Lords, I have learned about midnight flights for deportees to the Caribbean. I do not wish to interfere in any way with judicial processes, or even to suggest that, but would it not be a gesture of post-Brexit good will to declare what some countries have done: a carefully constructed amnesty leading into our next-stage immigration policy?

Baroness Williams of Trafford: The noble Viscount should be clear about what and whom he means when he talks about midnight flights. I do not know that they take place at midnight, but the people who are set to be deported to the Caribbean are rapists, murderers and people involved in drugs and firearms. Does the noble Viscount really mean an amnesty for serious criminality?

Viscount Waverley: No, I was talking about a more general point that possibly, going into a post-Brexit situation, the Home Office might wish to consider amnesty for certain types of individuals. It may find that helpful. That is all.

Baroness Williams of Trafford: I thank the noble Viscount for his clarification. Certainly, the approach that we took post Windrush was that the task force took not a lenient but a generous view when people came forward to try to prove their status and right to remain in this country. There was not a culture of saying no, but of saying yes when people tried to get that documentation approved.

Lord Paddick: My Lords, the Home Secretary insisted in the other place that the planned charter flights to deport people from the UK to Jamaica would involve only foreign national offenders, and the Minister has just talked about the sorts of individuals involved. But how can the Government be sure that they are foreign nationals, bearing in mind that hundreds of the Windrush generation who were entitled to live in the UK have been wrongly deported, made unemployed and denied benefits? How can the Government give British citizenship to those brought to this country as infants or children and pay compensation to those wrongly denied work and benefits but at the same time deport offenders who have similarly lived all their adult lives in the UK and have no memory of living anywhere else?

Baroness Williams of Trafford: The noble Lord asked how we can prove that everyone who is the subject of the debate today is a foreign national offender. I am reliably informed—and I have asked repeatedly—that all the people who will be deported are foreign national offenders. The answer is yes. They are not only foreign national offenders but serious criminals. On the subject of people who came here as infants or children, obviously someone who was here before 1973 would have an assumed status, but just because you came here as an infant or child does not exempt you from the provisions in the UK Borders Act 2007, which the Labour Government rightly brought in to ensure that people convicted and sentenced to 12 months or more should be deported.

Baroness Ludford: My Lords, will the Windrush unit, or something parallel to it in the sharing of expertise, be deployed to assist EU citizens? I am not thinking of those who have come since the free movement directive came into force 15 years ago but those who been here for many decades. One hears anecdotally about people—I saw a reference to someone the other day who had been here for 74 years. A lot of elderly people might be in a state of uncertainty and anxiety, and one sees the potential for similar issues to arise. Is the Home Office gearing up to deploy its expertise or personnel in those cases?

Baroness Williams of Trafford: Certainly, the Windrush task force has stood ready to help anyone who has been here since before 1988 and would like to regularise their status. It has not precluded people from member states of the European Union, and that would include older people.

Lord Kennedy of Southwark: I asked the Minister earlier about the process of oversight by Ministers. Can she explain that to us? Is it the Home Secretary or a group of Ministers? Can we have their names?  What is the process? Clearly, if things are going wrong—or not going wrong—we need to make sure that Ministers are in charge of the process.

Baroness Williams of Trafford: The noble Lord did ask me that and I apologise for not answering at the time. As he and the House will have seen, the Home Secretary took absolute ownership of this issue right from the start, but I am sure that he liaises with other Ministers such as the Immigration Minister.

Intermediate-range Nuclear Forces Treaty
 - Statement

Lord Ahmad of Wimbledon: My Lords, with the leave of the House, I shall repeat in the form of a Statement the Answer given to an Urgent Question in the other place on the Intermediate-Range Nuclear Forces Treaty. The Statement is as follows:
“When I had the opportunity to respond on this issue in the House last October, President Trump had just announced that it was the intention of the United States to end the Intermediate-Range Nuclear Forces Treaty unless Russia returned to full compliance. Let me once again set out the context. The INF treaty was the 1987 agreement between the United States and the Soviet Union that eliminated nuclear and conventional ground- launched ballistic and cruise missiles with a range of between 500 kilometres and 5,500 kilometres. For over three decades now, the INF treaty has played an important role in supporting Euro-Atlantic security, initially removing an entire class of US and Russian weapons, thus making a significant contribution to strategic stability.
While the UK is not a party to this bilateral treaty, we have always made it clear over the years that we ideally wish to see the treaty continue. However, for that to happen, the parties need to comply with their obligations. Sadly, this has not been the case. Despite numerous objections raised by a range of NATO allies going back more than five years, Russia has developed new missiles in direct contravention of the treaty. This includes the covert missile testing, producing and fielding of the 9M729 ground-launched cruise missile system. As NATO Secretary-General Jens Stoltenberg has said:
‘These new missiles are hard to detect. They are mobile. They are nuclear capable. They can reach European cities’.
The US, under both the Obama and the Trump Administrations, has made extensive efforts to encourage Russia to return to full and verifiable compliance. It was indeed the Obama Administration who, in 2014, first strongly called out Russia’s non-compliance with this treaty. It is important to acknowledge that, while doing so, the US has continued to meet its obligations under the treaty. However, the US, with the full support of its NATO allies, has been very clear that a situation where the US fully abided by the treaty and Russia did not was not sustainable. On 4 December last year, US Secretary of State Mike Pompeo announced that the US would suspend its participation in the INF treaty within 60 days—that is, by 2 February 2019—unless Russia returned to compliance.
This constituted an opportunity for Russia to address our shared concerns and to take steps to preserve the treaty. Allies took the opportunity to reiterate this point last month to the Russian Deputy Foreign Minister, Sergei Ryabkov, during the NATO-Russia Council meeting. I have to inform the House that Russia has not taken that opportunity. It has offered no credible response, only obfuscation and contradictions designed to mislead. This of course fits a wider pattern of behaviour from Russia aimed at undermining our collective security. We and all NATO allies therefore support the US decision to suspend its participation in the treaty and to trigger the formal withdrawal process. NATO is unified on this process.
It is Russia’s fault alone that we have arrived at this point. President Putin’s statements in the last few days announcing that Russia, too, will suspend its obligations was unsurprising given the fact that it has violated the treaty over the years. Nevertheless, even at this late stage, we urge Russia to change course. The treaty’s six-month withdrawal process offers Russia a final opportunity to return to compliance through the full and verifiable destruction of all its 9M729 systems. That is the best—indeed, the only—way to preserve the treaty.
We remain committed, as do the US and other NATO allies, to preserving effective arms control agreements, but we are also clear that for arms control to be effective, all signatories must respect their obligations. In the meantime, we are working closely with all our NATO allies on the implications for European security. We remain committed to ensuring that NATO has a robust defence posture to deter all threats. As NATO allies said on 2 February:
‘NATO continues to closely review the security implications of Russian intermediate-range missiles and will continue to take steps necessary to ensure the credibility and effectiveness of the Alliance’s overall deterrence and defence posture. We will continue to consult each other regularly with a view to ensuring our collective security’.
If this treaty falls, we and other NATO allies will hold Russia alone responsible. We urge Russia now to take a different course and to return to full and verifiable compliance”.

Lord Collins of Highbury: My Lords, I thank the Minister for repeating that response to the Urgent Question. As he repeated, and as Mark Field said yesterday in the other place, the treaty’s six-month withdrawal process offers Russia a final opportunity to return to compliance.
Last October, we had a similar Answer repeated in this Chamber. I asked the Minister whether we were consulted over the initial announcement. He said that the UK Government,
“continue to work very closely with the United States and other NATO allies to ensure that our efforts over the past 30 years are not just sustained but strengthened.”.—[Official Report, 24/10/18; col. 864.]
Will the Minister tell the House what steps the Government have taken to try to bring the US and Russian Governments back to the negotiations? Will he tell the House what discussions he or the Foreign Secretary have had with their US counterparts?
There is another issue here. I know this is a bilateral treaty, but what contact has the Foreign Secretary had with other countries, including China, which have developed INF-proscribed weapons, so that a future multilateral framework may be developed that could supersede and replace the INF treaty?

Lord Ahmad of Wimbledon: Taking the noble Lord’s last question first, he will know that the INF treaty is a bilateral treaty between the United States and the Soviet Union, as it then was, although he raised an important point about nuclear weapons more generally. I assure him that the United Kingdom continues to work, particularly through alliances such as NATO, against the continued proliferation of such weapons and to ensure that the limitation that can be applied to them is upheld. That is why we welcomed further agreements that have been signed between the United States and Russia, particularly in relation to the New START agreement, which seeks to address this issue.
The noble Lord asked about the relationship and the discussions which have been taking place. He is quite right that in October we had talks on this issue. After that statement by the US, the current US Administration has initiated a series of meetings with close allies, including NATO. We continue to exchange detailed information on Russian violations and how we may best achieve shared policy objectives.
The other thing that I would bring to the noble Lord’s notice is that the US first declared Russia to be in breach of its compliance with the INF treaty back in 2014. At no point during that time has Russia provided a credible response. Indeed, the first response from Russia was that it was compliant. It was only in 2017 that it acknowledged that the missiles in question exist.
On whether there was a specific notification from the US on this occasion, we had already had discussions with the US. The message about the exact timing of the President’s public announcement was not communicated directly, but the recent announcement came as no surprise, bearing in mind the October announcement.

Lord Campbell of Pittenweem: Will the Minister join me in putting aside questions of blame and responsibility, and consider the nature of nuclear arms control? It can reasonably be said that its architecture is crumbling before our eyes. It is not just the INF treaty; it is the Iran nuclear treaty, the prospects for renewal of the Strategic Arms Reduction Treaty between the United States and Russia—which are generally now described as very unlikely—and the fact that the comprehensive test-ban treaty, first available in September 1996, is still not yet in force. We have in front of us, in 2020, the next review conference of the nuclear non-proliferation treaty. Would the Minister like to share with us precisely what position the United Kingdom is going to take in 2020 on the nuclear non-proliferation treaty, given that all around us it appears that nuclear arms control is disappearing before our eyes?

Lord Ahmad of Wimbledon: The noble Lord is right to raise concerns. The United Kingdom and Her Majesty’s Government have raised these concerns directly. When it came to the Iran nuclear deal, notwithstanding the  United States’ decision, we were firm and strengthened our co-operation with our European allies to ensure that that treaty remains alive. We will continue to work with all allies—including, particularly, NATO—to ensure that proliferation can be addressed.
The noble Lord asked about the UK’s position across the piece on nuclear weapons. We have made it very clear through our actions that we are a responsible nuclear power. We have over the years reduced the number of our own nuclear weapons and we will continue to work with key partners, most prominently NATO, to ensure that any challenges and security risks are worked through to ensure that we can work towards the reduction of nuclear weapons. That said, the risks are real. Those countries which do not abide by their obligations put such issues at risk and therefore we implore Russia to take note. I hope that this six-month period provides a moment of reflection for Russia.

Lord Hamilton of Epsom: My Lords, my noble friend has pointed out that reservations about this treaty were expressed by the Obama presidency, long before President Trump was elected. Surely if one side breaks a treaty, it is time to abandon it altogether. On the point that the noble Lord, Lord Collins, made about bringing the two sides together, surely 60 days’ notice is quite long enough for the Russians to indicate that they are prepared to discuss this matter, and I believe that they have not done so.

Lord Ahmad of Wimbledon: My noble friend speaks with great insight on these matters and I agree with him. Since October, there has been some hope of notice being given. The United States has shown that it acted in line with its obligations—it continued to abide by the treaty—and it has to be made absolutely clear that it is because of Russian actions that we have reached this point. However, there remains a window of opportunity. In line with the details of that treaty, there remains a six-month window, during which there is an opportunity for Russia to step up to the mark and fulfil its obligations. However, I agree with my noble friend, bearing in mind that the first occasion on which its non-compliance was brought to light was in 2014 and it took another three years before there was even a basic acknowledgement by the Russians that these weapons existed. The challenge remains real and the UK supports the United States’ actions.

Lord Browne of Ladyton: My Lords, Europe has been the greatest beneficiary of this treaty since 1987. With the suspension of compliance by both the United States and Russia, Europe is now much less secure, and it will continue to be while that compliance is suspended. On the date in December when the United States gave Russia notice of its intention, there was a NATO Foreign Ministers’ meeting in Brussels. The statement from that meeting included the following paragraph:
“Allies are firmly committed to the preservation of effective international arms control, disarmament and non-proliferation. Therefore, we will continue to uphold, support, and further strengthen arms control, disarmament and non-proliferation, as a key element of Euro-Atlantic security”.
How does suspending compliance with a treaty of this nature fit with that commitment, and what steps will our Government take to live up to it? What are we going to do now to “further strengthen arms control” in the light of the deterioration that the noble Lord, Lord Campbell of Pittenweem, has so clearly described? We are heading for strategic problems with the new START because it is an Obama treaty and anything with Obama’s name on it is detested by the current President of the United States.

Lord Ahmad of Wimbledon: The noble Lord raises an important point about NATO’s previous statement. I specifically draw his attention to NATO’s statement of 1 February 2019 on this very issue. It said:
“NATO continues to closely review the security implication of Russian intermediate-range missiles and will continue to take steps necessary to ensure the credibility and effectiveness of the Alliance’s overall deterrence and defence posture”.
The NATO alliance is important, and we and all NATO partners, including the United States, are committed to it. The noble Lord will know that in April this year the next meeting of NATO will be hosted by Secretary of State Pompeo of the United States. The implication is that non-compliance and compliance have to be a two-way process. However, if from 2014 there is a clearly identified situation in which one side does not abide by the rules and does not comply, it is a tall order to expect the other side to comply. As I said, there is an opportunity for Russia to step up to the mark, and I am sure we hope that it will. However, based on experience, it might be an opportunity that is not taken up.

Sri Lanka
 - Question for Short Debate

Lord Naseby: To ask Her Majesty’s Government, following the resignation of the government of the United States from the United Nations Human Rights Council where they co-sponsored with the United Kingdom Resolution 30/1 in 2015 and Resolution 34/1 in 2017, in regard to Sri Lanka, and given the progress made towards many aspects highlighted in the resolutions, what assessment they have made of whether to annul or withdraw those resolutions.

Lord Naseby: My Lords, it is my privilege to introduce this debate this evening. In doing so, I declare an interest in that I started the All-Party Parliamentary Group on Sri Lanka in 1975 and had the privilege of being made its honorary president four years ago.
In a sense, this evening is almost an auspicious day in Sri Lankan terms. Yesterday was the 71st anniversary of the independence of Sri Lanka, so it is no young nation—indeed, it is a very senior nation—and, in democratic terms, it is looked upon as the leading democracy in that part of the world, with regular elections, Governments changing here and there, and so far, thankfully, no sign of any dictator.
The reason for this evening’s debate is very straightforward. I thought about this six months ago and realised that the UN Motions on Sri Lanka will be reviewed in March 2019—that is, next month—by the UNHCR in Geneva, and I decided to initiate a debate. It is, after all, nearly four years since the resolutions were passed, having originally been moved by the US and the UK. They were co-sponsored by the Government of Sri Lanka, who welcomed help along the way.
There are two resolutions: one was adopted in September 2015 and the other in March 2017. The key point about them is that they promoted reconciliation, accountability and human rights in Sri Lanka. The cause was really the war in Sri Lanka, and the end of that war has resulted in Eelam being something that nobody in Sri Lanka, other than the Tamil Tigers, really wants. Certainly it is not wanted today and it is not wanted by India. However, unfortunately the UN received the Darusman report, which indicated that 40,000 civilians had been killed.
I have done a great deal of research. Nearly three years ago I made a request under the Freedom of Information Act and secured the publication of Colonel Gash’s dispatches to the United Kingdom. I have 40 pages of them here, some of which have been totally redacted, and I shall quote from one this evening. It is the dispatch of 16 February 2009 and concerns 400 IDPs being transferred from the fighting area to Trincomalee. Colonel Gash writes:
“The operation was efficient and effective, but most importantly was carried out with compassion, respect and concern. I am entirely certain that this was genuine—my presence was not planned and was based on a sudden opportunity”.
There are many more references in the dispatches to the fact that it was never a policy of the Sri Lankan Government to kill civilians.
I have one other reference that I think is useful. It comes from the University Teachers for Human Rights, which is essentially a Tamil organisation. It says:
“From what has happened we cannot say that the purpose of bombing or shelling by the government forces was to kill civilians … ground troops took care not to harm civilians”.
There is a host of other references but I shall quote one more:
“Soldiers who entered the No Fire Zone on 19th April 2009 and again on the 9th and 15th May acted with considerable credit when they reached … civilians. They took risks to protect civilians and helped … the elderly who could not walk. Those who escaped have readily acknowledged this”.
Again, that provides proof.
Interestingly, the US has now withdrawn from being a sponsor. My personal guess, following some inquiries, is that the US Government now assess that the Sri Lankan Government have done a huge amount to meet the UN requirements, so they see very little purpose in prolonging what is in effect almost a policing surveillance of the actions of another sovereign state which is now 71 years old. Nevertheless, I think it is right to evaluate what has happened over the last four years.
I pay tribute to Her Majesty’s Government for some of the help they have given, particularly in the reconciliation process, through their Conflict, Stability and Security Fund. The HALO Trust has done a  wonderful job. I have visited the de-mining operation on two occasions and have seen the very careful work of a Sri Lankan individual clearing one square metre a day. It is very dangerous work and is being done beautifully, so I thank all those involved and look forward to the day in 2020 when the million-plus mines will have been removed.
The UK has also assisted in setting up the Office on Missing Persons. Reflecting on the work I have done, I have noticed that more and more missing persons have reappeared. I received notification three weeks ago of a well-known Tamil activist appearing in the middle of France, complete with wife and children. I believe that this is not terribly unusual, but it is quite some time since the war ended and people are still reappearing.
The Sri Lankan Government have set up their Office for Reparations, which is useful and doing good work. They have also set up a framework for a truth and reconciliation commission. This is absolutely vital in my judgment. It means that all those who were involved have to be prepared to come and give evidence, including members of the LTTE who have disappeared to Canada, the USA or Australia. They must be subpoenaed to attend; otherwise the process will be totally one-sided. Even in the UK, we still have people such as Mrs Balasingham who was a real activist for the LTTE in the recruitment of child soldiers.
I understand why the Sri Lankan Government believe that the judges should be Sri Lankan; I think that they are right. If nothing else, the recent argument in the Supreme Court indicated that the Supreme Court rules supreme in Sri Lanka, whatever the politicians might think. There is a new counterterrorism Act on the way; 90% of the land requisitioned during the war has now been returned to the original citizens; 880,000 displaced people have been resettled, which is a huge achievement, by any yardstick, for any country; and 12,000 former LTTE cadres have been rehabilitated and integrated back into society—I have met some of them, and they are most grateful for what was done for them.
In reality, Sri Lanka has taken positive steps on the four pillars of transitional justice: truth, reconciliation, accountability and guarantees of non-recurrence, which must be taken into account by the Human Rights Council. Add to this the continuing co-operation, almost on a daily basis, with human rights people on the ground in Sri Lanka and the question has to be asked: what is the point of continuing with these resolutions?
It is 10 years, almost to the day, since the end of the war. Surely now is the time for closure and to let this proud country stand on its own two feet. Is it really a good use of resources for Sri Lanka to be monitored by the West almost every day? My view as president of the all-party group is: no, it is not. Frankly, I say to my noble friend on the Front Bench, too easily do we forget what a good friend Sri Lanka has been to the UK over decades. When it was a colony, thousands of Sri Lankans volunteered for the two World Wars. Indeed, the eighth-largest number of people who gave their lives for us in the United Kingdom were from this small island; and, as my noble friend must know, Sri Lanka was one of just seven countries to support us over the Falklands War.
There is a very old adage, “Keep your friendships in repair”. Today, there is peace in Sri Lanka. You can go wherever you like. In the north, the infrastructure is repaired—that is pretty crucial—and the trains run on time. They do not run on time on the Peterborough line, I can tell you. The final proof of the normality of life are the 254,176 visitors from the UK who went to Sri Lanka in 2018—up 20%. They voted with their money and feet. I submit that Her Majesty’s Government should do the same in Geneva: recognise the good, genuine work done, show some leadership, bring closure to the UN resolution and, in doing so, make it quite clear that there were not 40,000 civilians killed—and, if it helps, I will give all the evidence I have to my noble friend on the Front Bench, so that he can be totally convinced that that is indeed the case.

Lord Framlingham: My Lords, I start by congratulating my noble friend Lord Naseby on obtaining this most important and timely debate. It is many years since I visited Sri Lanka as part of an all-party delegation led by him. I am not an expert on Sri Lankan affairs and do not pretend to speak with any authority but simply as someone who cares for Sri Lanka and who has watched with great sadness as it has gone from being an idyllic island, through indescribable horrors, and is now in the difficult process of reconciliation and rebuilding.
Our visit gave us an opportunity to undertake a comprehensive survey of the island at that time; I have the most vivid memories of what we saw and the people we met. Everyone was extremely welcoming, the politicians were helpful, the tea plantations were fascinating and the landscape and beaches were beautiful. Even the place names were entrancing: Jaffna, Kandy, Trincomalee. I recall visiting what were called the tea lines: rows of low, whitewashed cottages where the tea pickers lived. We were there to study the workers’ welfare and the conditions under which they lived. I will never forget, as we got back on our coach, looking at the somewhat anxious and drawn faces of my parliamentary colleagues and comparing them with the smiling and contented faces of the tea pickers, about whose welfare we were so concerned.
We had, of course, a comprehensive series of political meetings. We were made well aware of the dark clouds that were gathering and the reasons for them. The situation became even more obvious to us, and a little threatening, when we were warned to take great care when visiting the city of Jaffna; the army based there at that time were so beleaguered that they left their barracks only to buy cigarettes and then only under armed guard. Soon after we left Colombo, there was an explosion in the hotel in which we had stayed. I believe that was the beginning of all the tragic events that followed and which are now only too well known by everyone. I still find it hard to imagine the people I met enduring the suffering that ensued.
After such terrible times, the task of rebuilding both trust and structures is huge. Sadly, this is not new to the world. South Africa and Northern Ireland are just two examples that remind us of all that is needed to make it work—to bring people together and rebuild co-operation and confidence.
In all this, the role of the United Nations—the subject of this debate—is very important. It must of course bring pressure to bear to maintain stability and move the various processes forward. These are the principal reasons for the resolutions that we are debating this evening. But the UN must always be prepared to provide assistance, understanding and an acknowledgement of progress being made. It is surely right at this juncture that, in taking any decision on its resolutions, the United Nations should take account of the progress to date and ask itself what purposes its resolutions are designed to achieve.
It is now 10 years since the end of the conflict, and much progress has been made. My noble friend has listed many of the advances: an independent and permanent Office on Missing Persons has been set up and is working; the Parliament has passed an Act to establish an Office for Reparations; a draft framework on the establishment of a truth and reconciliation commission has been submitted to the Cabinet of Ministers; new counterterrorism legislation is under consideration; 90% of state and private land used by the security forces has now been handed back for civilian use; around 800,000 displaced people have been resettled; and Sri Lanka is due to be declared a mine-free zone in 2020.
Alongside politics and the restoration of civic life, trade helps enormously to get a country back on its feet. The UK remains the second biggest market for Sri Lankan exports after the USA. We account for around one-third of Sri Lankan exports to the EU and are one of the major investors in Sri Lanka.
Tourism of course plays a major role in the life and economy of the country. Sri Lanka was rated by the Lonely Planet guide as a top destination for travellers in the coming year 2019, and in 2017 there was a 20% increase in tourists from the UK. There was an almost 30% increase in the number of cruise ships calling at Colombo port in the first 10 months of 2018, and it is now one of the world’s fastest-growing ports. So great strides have been and are being made on all fronts. It is in the light of that progress that we are asked to consider the UN resolutions.
The Irish Times described Sri Lanka as:
“A tear-drop-shaped island that’s heaven on earth”.
In recent years, through civil war and tsunami, it has had its share of tears. The hope must be that everyone who cares for this wonderful island, including our own Government and the UN, will do all that they possibly can to help it to continue on its way to a safe and prosperous future.

Lord Low of Dalston: My Lords, I too am grateful to the noble Lord, Lord Naseby, for asking this Question for Short Debate.
I first became involved with Sri Lanka shortly after I joined this House, when I was invited to become a patron of DABAL, Deaf And Blind Aid Lanka, a small organisation of highly committed people in this country who raised funds for the support of schools for deaf and blind children in Sri Lanka. I declare my interest as a vice-president of the Royal National  Institute of Blind People. Thanks to the good offices of the members of DABAL, I had the opportunity to visit Sri Lanka last summer and see for myself some of the schools that it assisted. Although the schools were staffed by highly dedicated individuals, it was clear that in all but two cases that had the benefit of private funding, the schools were chronically short of resources. We left hoping that the Government would do more in future to support the education of deaf and blind children in Sri Lanka.
I turn to the matters that are the specific subject of this debate. Like the noble Lord, Lord Framlingham, I am not an expert on the politics of Sri Lanka, so I shall just speak quite briefly. The essential question is how far a peacetime regime has truly replaced the kind of things that go on during war. As we have heard, in September 2015 and March 2017 the UN Human Rights Council adopted two resolutions requesting the Government of Sri Lanka to set up transitional justice mechanisms to address issues of reconciliation. The resolutions were co-sponsored by the Sri Lankan Government. If we look at what has happened since the end of the conflict in 2009, it is clear that the Sri Lankan Government have taken significant steps towards reconciliation, yet I am aware that Sri Lanka remains the object of considerable criticism from the international community. According to Amnesty International, Sri Lanka continues to pursue the commitments that it made in 2015 to deliver justice, truth, reparation and guarantees that crimes under international law will not recur but progress has slowed. There is still evidence of torture and other ill-treatment in police custody, while the Prevention of Terrorism Act is still used to arrest and detain suspects.
However, the positive steps that Sri Lanka has taken on the four pillars of transitional justice—truth, reconciliation, accountability and guarantees of non-recurrence—need to be recognised. We have heard about some of them already. An independent and permanent Office on Missing Persons has been set up. An Act to establish an Office for Reparations has been passed by the Parliament. Proposals have been brought forward for the establishment of a truth and reconciliation commission. New counterterrorism legislation that will repeal the existing Act and bring legislation into line with human rights standards is under consideration by the Parliament. As we have heard, 90% of state and private land used by security forces in the north and east of the island has been released for civilian use. As we heard from the noble Lord, Lord Naseby, around 880,000 displaced persons have been resettled, and around 12,000 former Tamil Tigers have been integrated back into society.
From this, I think it is clear that the Sri Lankan Government have done a great deal. However, there is still more to do and the Government cannot yet completely relax their efforts to bind up the wounds of a society that has so recently been riven by a protracted period of civil strife.

Lord Sheikh: My Lords, I thank my noble friend, Lord Naseby, for this timely debate regarding Sri Lanka and Resolutions 30/1 and 34/1.
I have visited Sri Lanka on three occasions. I have travelled to various parts of the country and met Sri Lanka’s leadership and other senior figures. My travels to and around Sri Lanka also allowed me to see first-hand the situation on the ground. Sri Lanka suffered a 26 year-long civil war that produced a great deal of suffering. The conflict ended 10 years ago and Sri Lankans are well on their way to reconcile, rebuild and reform.
During my visits to Sri Lanka I visited the Northern and Eastern provinces, where some of the land was occupied by the security services. The Tamil politicians were against the Government. I visited the Menik Farm camp for displaced Tamils. While much of the propaganda at the time was that they were confined to the camps, I observed that even at that time the displaced persons could come and go as they wished, and in fact I spoke to some of them. It is important that the displaced persons should be settled and rehabilitated. During my discussions with various Sri Lankans, I was made aware that there was a great deal of concern about missing persons.
I went to Kilinochchi, where demining was being undertaken by the HALO Trust, and I noted that it was indeed a very slow process. In Jaffna, I talked to ex-combatants who were being trained by the Government to obtain skills. Even today I closely follow the developments in Sri Lanka, and I cannot help noting the tremendous progress that the country has made to tackle burning issues, especially over the last three years.
I shall outline some of the key achievements of the country since then. The UK has now become the sponsor of the resolutions, which makes it imperative for us to take stock of those developments. The Sri Lankan Government have now declared that the country will be free of landmines by 2020, and Sri Lanka is part of the landmine ban convention signed in Ottawa in September 1997, which was supported by the UK as well. Over 880,000 displaced persons have been resettled since the end of the conflict in 2009. Sri Lankan security forces have returned 90% of the state and private land they had been occupying and the remaining figure is less than 10%. Over 12,000 ex-combatants, including around 600 child soldiers, have been rehabilitated and reintegrated into society, with some pursuing higher studies or other vocations.
As I said earlier, I have spoken to some of the ex-combatants. Sri Lanka has now taken ownership of mechanisms created under the four pillars of transitional justice: truth, reconciliation, accountability and guarantees of non-recurrence. This includes the Office on Missing Persons, which has been set up and is now functioning well. It is due to open 12 regional offices. Sri Lanka has also ratified the International Convention for the Protection of All Persons from Enforced Disappearances and, incidentally, the country is now party to all nine core United Nations human rights instruments.
Another mechanism of transitional justice is the Office for Reparations, established and passed in Parliament on 10 October 2018. Today, the commissioners are in the course of being appointed. The draft framework for a truth and reconciliation commission has been submitted to the Cabinet Ministers by the Prime Minister.
An area for reform which has had national and international attention is the review and repeal of the Prevention of Terrorism Act. This will be replaced by the counter terrorism Act, which is in line with human rights standards. A Bill was presented in Parliament last year, after which it was challenged by some parties in the Supreme Court. The Supreme Court of the country has proposed some amendments which are now being considered at the committee stage in Parliament.
The Government have also become party to the optional protocol to the UN Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, which shows that they are taking allegations of torture very seriously and remain committed to carrying out investigations and prosecuting perpetrators. Sri Lanka has also retained a moratorium on the death penalty since 1976; I very much appreciate this action, as I am totally against the use of the death penalty.
These are some of the steps Sri Lanka has undertaken to engage fully with UN conventions on human rights. Sri Lanka respects the UN’s systems and processes, has transparent processes and legislation regarding human rights and welcomes UN investigations into compliance. Furthermore, there is reconciliation between political parties where moderate Tamil parties play a significant role in democracy and government. As I mentioned earlier, the Tamil politicians were previously totally against the Government. I also add that, during the recent constitutional problems, the Tamil National Alliance played a key role and supported the democratic institutions in the country.
After 10 years of conflict, I feel it is fair to say that Sri Lanka is now graduating to upper middle income status. It is a recipient of the GSP+ tariff concessions of the European Union, which are based on adherence to core UN conventions on human rights, labour rights and the environment. Lonely Planet has termed Sri Lanka the best destination to visit for 2019, and I hope to visit as soon as I can. With the upcoming Port City on its western coast, it is fast becoming a hub in the Indian Ocean. It will bring more trade to the country and wealth and prosperity to all Sri Lankans.
Last October, I had the pleasure of receiving a personal briefing on Sri Lanka’s development plans from the Minister in charge, Mr Ranawaka. I have developed a good relationship with the Sri Lankan High Commission here in London and I would like to make a personal comment on Sri Lanka’s spirit for reconciliation between the communities. Throughout the year, the high commission holds different functions to celebrate religious holidays. Last year, I attended and spoke at the Christmas celebration held at the high commission. Even though Christians are a minority in Sri Lanka, making up 8% of the population, Christmas is celebrated in the country and at the high commission in London. It was significant that the diaspora attended the function at the Sri Lanka High Commission; it was a good example of promoting reconciliation, with the Sinhalese and Tamil chaplains of the Catholic Church in attendance.
Finally, I ask the Minister whether the Government appreciate the important progress Sri Lanka has made. What is being done to help Sri Lanka and what more can be done? I also ask whether there is any point in the resolutions being continued. Can there now be closure?

Baroness Northover: My Lords, the noble Lord, Lord Naseby, has a long record of engagement in Sri Lanka, and over the years, the Governments there will have been very grateful to him for that support. I thank him for his detailed briefing documents, which other speakers have clearly derived information from, even though these do not quite square with the material I received from the House of Lords Library and elsewhere.
It was very welcome when the long-standing conflict in Sri Lanka came to an end. Its conclusion was very brutal, as the Government sought the total defeat of the Tamils. The UN claims that during this final offensive as many as 40,000 civilians were killed. The human rights abuses allegedly committed against the Tamils included enforced disappearances, torture and arbitrary arrest, though both sides have been accused of war crimes.
When President Sirisena, although a former ally of Rajapaksa’s, was elected in 2015, it was a surprise win over the former President, who had a reputation for having encouraged severe repression of the minority Tamils. It was seen as a step in the right direction. The new President was backed by the Tamil National Alliance, as well as Tamil-speaking Muslims, largely due to his expressed commitment to reconciliation and government accountability. In coalition government, Mr Wickremasinghe—I apologise if I have not pronounced that correctly—became his Prime Minister, and halting but insufficient steps were taken toward addressing issues of accountability, missing persons, governance and land usage.
The last year has seen a move away from this settlement. The President dismissed the Prime Minister in October 2018 and, astonishingly, installed Rajapaksa instead. The original Prime Minister refused to step down. MPs voted to reinstate him twice, upon which the President tried to dissolve Parliament. He also attempted to call a snap election. Rajapaksa began operating with his own newly formed Cabinet, but an appeals court restrained this. In December, the Supreme Court ruled that the President had acted unconstitutionally; the original Prime Minister was reinstated. One of the encouraging features of this crisis has been the way in which the courts have played a key role in upholding the Sri Lankan constitution. In this unstable situation, should the international community back away from the Human Rights Council resolutions in the light of the US withdrawal, which three noble Lords have just indicated should happen?
Resolution 30/1 in 2015 outlined many steps that the Government should take towards truth, justice, reparation and the prevention of human rights violations. Resolution 34/1 in 2017 called for any outstanding elements of the original resolution to be fully implemented. Sri Lanka co-sponsored both resolutions alongside the UK, the US, Macedonia and Montenegro. These resolutions will expire in March 2019, which is why this debate is indeed timely.
The implementation of these resolutions has been very slow. The first resolution committed to establishing four transitional justice mechanisms, including an Office on Missing Persons, an Office for Reparations, a truth  and reconciliation commission and a judicial mechanism to investigate violations of human rights and international humanitarian law. So far, only one of these goals has been partially met, with the formation of the Office on Missing Persons in September 2018. However, the recommendations in the interim office’s reports have not been implemented by the Government, although the briefing of the noble Lord, Lord Naseby, tells us that the Ministry of Finance is looking to include necessary funds in this year’s budget. Can the Minister say whether the UK Government understand that to be the case? Does he have any explanation as to why this is taking so long?
A Bill to create an Office for Reparations was narrowly passed in October 2018 but no concrete steps towards implementation have yet been taken. The briefing of the noble Lord, Lord Naseby, states that nominations to this office will be approved by the President. Is the Minister concerned about that? The draconian Prevention of Terrorism Act remains in place, despite the recommendation to review and repeal it. New anti-terror legislation is under review but is still not up to international legal standards. Some steps have indeed been taken on returning land. In October 2018, the President finally called on authorities to return land in the north and east by the end of the year. The noble Lord’s briefing reiterates this. However, Amnesty notes that the authorities are yet to comply fully with this request and emphasises that many communities remain displaced.
Amnesty also notes that welcome investigations have been opened into attacks on journalists, human rights defenders, religious minorities and civil society organisations. These investigations, however, have not resulted in any convictions. It describes,
“dismayingly limited progress on accountability for torture, rape, sexual abuse and gender-based violence”.
Sri Lanka established a consultative task force on reconciliation in January 2016. Over 7,000 Sri Lankans were consulted for the task force’s report, which urged the Government to chart a road map for fulfilling the UNHRC resolutions. But according to Amnesty the Government have ignored the task force’s findings, with the Minister of Justice saying that he had “no confidence” in them.
Under Resolution 30/1, a judicial mechanism—including the participation of Commonwealth and other foreign judges, also referred to as hybrid courts—was proposed by the Sri Lankan Government. To date, there has been no progress on this front. In fact, the Government have backtracked on their own commitments. In 2018, the President called for the international community to give Sri Lanka the room to solve the problems it is facing on its own. Government officials have rejected the involvement of foreign nationals in the hybrid courts. This kind of hybrid court surely must be held to, as was the case in Cambodia.
Many Tamils and most of the international community feel that reconciliation has stalled. For example, the President was meant to bring about a new constitution that would devolve more powers to the provinces, including land registration and police power, which would increase Tamil self-determination. Talks on constitutional reform have been gridlocked and devolution  is now seen as a broken promise. The Tamil advocacy group Together Against Genocide has said that the Foreign Minister’s international statements are contradicted by what senior government officials do in practice; the Verité Research Group has echoed this.
In 2017, after a fact-finding mission, UN special rapporteur Pablo de Greiff said that the reconciliation process had become increasingly ethnicised, with transitional justice,
“represented as if it were essentially a threat to the majority community”.
The UK has supported implementation of the resolutions through the Conflict, Stability and Security Fund. The programme’s mandate will expire in 2019. What plans are there to renew it? With the US’s withdrawal from the Human Rights Council, there is concern that there will be less pressure put on Sri Lanka to implement the resolutions. The US has said that it will continue to engage with Sri Lanka on truth and reconciliation, despite its withdrawal, but no concrete steps have yet been announced. Can the Minister report on any discussions with the US on this matter?
Amnesty notes:
“As the tenth anniversary of the end of Sri Lanka’s internal conflict looms in May, progress on UN Human Rights Council Resolution 30/1 has proceeded at a glacial pace, the hopes of the victims of crimes under international law and human rights violations and abuses during the conflict have been reduced to a flicker”.
This does not argue for the international community to back away. Clearly, as we saw last year, Sri Lanka is in an unstable political situation. Progress thus far is of course to be welcomed, particularly the role of the courts in last year’s political manoeuvres, but progress must be put in the context of what has been promised and needs to be achieved. It would be premature to remove any of the pressure on Sri Lanka to adhere to the Human Rights Council’s conclusions and I hope that the Minister will share that view.

Lord Collins of Highbury: My Lords, I too welcome the opportunity that the noble Lord, Lord Naseby, has given us to address the issues in Sri Lanka. There is no doubt that there has been progress but, as the noble Baroness, Lady Northover, said, it has been glacial. When we talk about truth, reconciliation and—the most important element—peace, we must not forget accountability. That is vital to ensure that reconciliation is sustainable. From the response to a number of Written Questions, it certainly seems clear that the United Kingdom remains committed to the full implementation of the UN Human Rights Council resolutions, particularly Resolution 34/1. As the noble Baroness also highlighted, there has been such limited progress on accountability.
There is therefore a clear expectation among the Sri Lanka core group in Geneva, consisting of the United Kingdom and Germany, to ensure the adoption of a further rollover resolution at the upcoming Human Rights Council session, with the co-sponsorship of the Government of Sri Lanka. However, there is a great deal of concern that support from the Sri Lankan Government, which emanates largely from their Prime Minister’s office and is perhaps better described as grudging acquiescence, could be derailed in the light  of the open conflict between the Prime Minister and President of Sri Lanka, especially after the events of last December, as described by the noble Baroness, Lady Northover.
It would be easy to see the President seeking to gain political advantage by making a stink of the notion that the Prime Minister’s party, the UNP, is selling out war heroes. The fact that we are having this debate leads me to think that there is absolutely no room for complacency. It is important to refocus our minds on the central reason that Sri Lanka came before the HRC in the first place: allegations of atrocity crimes. The fact is that these have not in any sense been addressed.
In his debate in October 2017, which I also participated in, the noble Lord, Lord Naseby, argued that the Government should drop their call for a credible accountability process to look into the wartime violations in Sri Lanka, in view of the exonerating contents of a series of confidential wartime British diplomatic dispatches obtained from the FCO via FoI request. The noble Lord referred to that again this evening. As it happens, in June 2018 Private Eye referred to the Sri Lanka Campaign’s similar request for FoI over these dispatches. Its assessment suggested in particular that the casualty figures to which the noble Lord referred did not represent the independent assessment of the UK military’s attaché, but rather were derived from UN Country Team estimates, which have been in the public domain since 2009 and remarked upon by subsequent UN investigations for the conservative nature of their methodology.
The other thing in that debate was giving the wrong impression that the statement “no cluster munitions were used” was attributable to, and represented the independent assessment of, the UK military attaché. As Private Eye revealed, this was in fact a description of the position of the then Sri Lankan Defence Secretary, Gotabaya Rajapaksa, an alleged perpetrator of grave human rights violations. Sadly, your Lordships’ debate of 14 months ago continues to be used by hardliners in Sri Lanka to erode efforts to bring about a meaningful process of accountability and reconciliation for wartime atrocities. For example, in July last year, GL Peiris, a member of the former regime and Mahinda Rajapaksa ally, wrote to the new UK Foreign Secretary, calling on him to withdraw the UN Human Rights Council resolution on Sri Lanka, in view of the “entirely flawed” basis for it, as revealed by the noble Lord, Lord Naseby.
Many are concerned about how that FoI request and the dispatches will be used to sway international public opinion at crunch time at the Human Rights Council in March— next month. Therefore it is important to correct the dangerous and unhelpful narrative that the original debate of the noble Lord, Lord Naseby, has helped to foment in Sri Lanka.
If we are talking about anniversaries, as documented in great detail by the United Nations High Commissioner for Human Rights’ 2015 investigation—

Lord Naseby: My freedom of information request was duly passed to me. It is my privilege, according to the judge of the First-tier tribunal, to use that information as I see fit. I am more than happy to give copies to all  Front-Bench persons present, and will make sure that happens immediately. However, those dispatches are not written by me, they are written by the official attaché from the United Kingdom who served throughout the war and was at the front line during that war.

Lord Collins of Highbury: I am grateful for the offer. I am sorry it has come 14 months late, but I would have appreciated—and certainly the campaign for Sri Lanka would have appreciated—copies earlier. That is why, according to Private Eye, it put in its own FoI requests and has got the material. The important point about the narrative that we have heard this evening, which the noble Baroness, Lady Northover, also made, is that we want to see the full implementation of the resolution, which has not been properly addressed and certainly in no way can be considered fully addressed.
I want to point out something in that report of the UN High Commissioner for Human Rights in 2015 into the final stages of the civil war. On this day—5 February—10 years ago, the UN, the International Committee of the Red Cross and medical workers were finally forced to evacuate from PTK hospital. For three weeks, the hospital had been subjected to intense shelling by suspected government forces, which continued despite—or perhaps because of—the GPS co-ordinates having been communicated to them. It was the only hospital in the war zone that was equipped with an operating theatre, where hundreds of patients were being treated. To quote the report:
“Witnesses told investigators that as shells fell, people ran to take cover, including several patients who ran towards bunkers located outside the hospital, carrying their intravenous drips with them”.
An attack on 3 February,
“hit a ward with women and children, killing at least four patients and injuring at least 14 others. The hospital was hit again during the following evening, damaging the children’s ward, reportedly killing seven people, including one medical staff member and a baby … One hospital worker described the situation in the hospital by 4 February as ‘carnage’, the likes of which she had never seen before”.
As we approach the 10th anniversary of these events, I hope the Minister will join me in expressing concern that, despite the various promises made by the Government of Sri Lanka before the Human Rights Council in October 2015, they have not yet succeeded in holding accountable a single member of the Sri Lankan armed forces for those appalling atrocities. I hope that he will reassure us that we will seek full implementation of those UN resolutions.

Lord Ahmad of Wimbledon: My Lords, I join all noble Lords in thanking my noble friend Lord Naseby for securing this timely debate. I pay tribute to his long-standing commitment to Sri Lanka, including in his current role as president of the all-party parliamentary group. I thank all noble Lords for their thoughtful contributions to this debate, which, as we have been reminded, comes at an important point in the run-up to the 40th session of the United Nations Human Rights Council in Geneva, which my right honourable friend the Foreign Secretary and I hope to attend, and its assessment of progress made by Sri Lanka  in implementing its commitments under Resolution 30/1. As my noble friend is aware, that resolution, together with Resolution 34/1, set out a number of actions to be taken by the Government of Sri Lanka to further accountability—a point well made by the noble Lord, Lord Collins—reconciliation and human rights following the end of the decades-long civil war.
I make the Government’s position clear from the outset: Her Majesty’s Government have no plans to annul or withdraw those resolutions. The UK continues to believe that full implementation is essential, as the noble Baroness, Lady Northover, and the noble Lord, Lord Collins, made clear. Without truth, justice, and guarantees of non-recurrence, there can be no lasting reconciliation. In co-sponsoring Resolution 30/1, the Government of Sri Lanka also sent a clear signal that they recognised this.
My noble friend Lord Naseby rightly noted that the United States co-sponsored the resolutions. As I have said before from the Dispatch Box, we deeply regret the decision of the United States Government to resign from the Human Rights Council. However, as leader of the resolutions core group, we remain determined to see them implemented in full. To that end, and following consultation with the core group, I am pleased to notify your Lordships’ House that Canada and Germany have agreed to join the United Kingdom, Macedonia and Montenegro as alternate sponsors. Both Canada and Germany share our understanding of the importance of achieving reconciliation in Sri Lanka. At the same time, the US remains a strong external supporter of the resolution and an advocate for progress, a point made by the noble Baroness, Lady Northover.
On 21 March 2018, the UN High Commissioner for Human Rights rightly recognised the steps taken since January 2015 to improve the human rights situation in Sri Lanka, a point well made by my noble friend Lord Framlingham. We echo that report. As the UK’s Human Rights Minister, I welcome progress on the restoration of important democratic checks and balances, improvements in respect for freedoms of expression and movement, the return of land held by the military to civilians, the establishment of the Office on Missing Persons, the ratification of the convention on enforced disappearances, and the passing into law of, and budget allocation for, the Office for Reparations Bill.
My noble friend Lord Sheikh raised the important issue of land rights. We welcomed the Sri Lankan Government’s instruction to the military in 2016 that all land obtained from civilians should be released at the latest by 2018. However, as of January 2019, some land is still to be released. We encourage land returns. I assure noble Lords that, as a friend of Sri Lanka, we continue to support the return of land to civilians through direct funding for demining activities—mentioned by my noble friend—in the north of the country. In August 2018, my right honourable friend the Minister for Asia, Mark Field, announced a further £1 million increase in funding to support family resettlement and peacebuilding. From a governance perspective, while progress clearly still needs to be made, it is clear that Sri Lankans do not live in the same climate of fear that existed under the former Government, and that  people now have greater confidence to speak openly and honestly, and with rising media freedom, about the challenges faced by the country. This point was well made by the noble Lord, Lord Low.
On the issues that confront the country, it is clear that the pace of change has been disappointingly slow, as the noble Baroness, Lady Northover, recognised. We must see further and faster progress by Sri Lanka towards implementing its commitments under Resolution 30/1. I will outline the further steps on four key issues. First, as the noble Lord, Lord Collins, reminded the House, is the establishment of a transitional justice mechanism, including a truth and reconciliation commission. Second is the urgent repeal and replacement of the Prevention of Terrorism Act. I assure the noble Baroness, Lady Northover, that the British high commission in Colombo is in regular contact with government officials, including Tamil National Alliance MPs and civil society representatives, about the situation of detainees held under the PTA. We also continue to work on this issue with other diplomatic missions, including the EU and UN bodies.
The noble Baroness also asked whether funding for the Office on Missing Persons has been included in the budget. I understand that that office has now been established and is operating. However, a final decision has yet to be taken on funding the establishment of the Office for Reparations.
This underlines the important fact that the legacy of Sri Lanka’s recent conflict can be addressed and lasting reconciliation achieved only if we see further progress in this regard. As the noble Baroness also rightly pointed out, there were deep concerns over recent political developments at the end of 2018, when President Sirisena dissolved the Parliament, in an apparently unconstitutional manner, in an attempt to dismiss Prime Minister Wickremasinghe and install former President Rajapaksa in his place. Ultimately, the peaceful resolution of the 51-day crisis was a welcome indication of resilience, as noble Lords have recognised. We need to recognise the progress that has been made in Sri Lanka’s judicial and democratic institutions and on the effective checks and balances between state powers. This is an important step forward, but there were 51 more days when progress towards reconciliation came to a halt.
We have repeatedly urged the Government of Sri Lanka to go further and faster. On 21 January, I met the Minister of Finance and Mass Media, Mangala Samaraweera, in London. He has been a strong supporter of Sri Lanka’s commitments to Resolution 30/1. It was a pleasant and constructive meeting, during which he took the opportunity to engage directly with representatives of the diaspora in the UK, including members of the Tamil community. My honourable friend the Minister for Asia and the Pacific did the same when he met Foreign Minister Marapana and a number of other Sri Lankan Ministers and officials in  Colombo last October. Last September, the UK led a statement on behalf of the core group at the 39th session of the Human Rights Council, urging Sri Lanka to prioritise and drive forward the implementation of its commitments.
The noble Baroness, Lady Northover, asked questions about CSSF funding. We are providing £8.3 million for the current period and are evaluating projects and proposals for continued funding. She also asked whether the President would appoint commissioners for the Office on Missing Persons. We hope and expect that President Sirisena will appoint commissioners who command the full support of all communities.
The noble Lord, Lord Collins, asked an important question about the current situation in terms of accountability. There has been progress. The British Government are a friend of Sri Lanka and have supported projects to ensure a zero-tolerance approach to rape and gender-based violence in Sri Lanka. This has included the funding of a helpline for victims of domestic abuse and increasing police support for women and children. I assure him that the UK continues to support efforts by the Sri Lankan Government to develop a more professional and accountable police force, including increasing gender-sensitive policing. We have raised issues across the whole spectrum of human rights and continue to support various NGOs working in the community, including support for the Sri Lankan LGBT community.
Let me be very clear and assure all noble Lords that the United Kingdom is a friend of Sri Lanka. We have made a long-term commitment to work with Sri Lanka on improving human rights and supporting the rebuilding of the country after three decades of conflict. Our £8.3 million of funding over three years is an example of this. On the strength of our relationship, I know that my noble friend Lord Sheikh mentioned the positive outreach conducted by the high commission here in London. I very much look forward to paying tribute to the breadth and strength of our bilateral relationship with Sri Lanka when I speak at the Sri Lankan high commission tomorrow to recognise and celebrate Independence Day.
The UK remains convinced that Resolution 30/1 must be implemented in full if Sri Lanka is to achieve the long-term reconciliation that all its people need and, we all recognise, truly deserve. We recognise that progress has been made, as my noble friend highlighted in tabling this debate, but we also believe that—with a concerted effort by Sri Lanka and support from co-sponsors including the United Kingdom, as well as external advocates including the United States, the European Union and the UNHRC—Resolution 30/1 can be fully implemented, allowing Sri Lanka to realise the true potential we all seek, as a stable prosperous country providing growth and opportunities for all Sri Lankans.
House adjourned at 8.30 pm.